understanding of qualitative research process

The qualitative research process, end-to-end

.css-1nrevy2{position:relative;display:inline-block;} The qualitative research process: step by step guide

Although research processes may vary by methodology or project team, some fundamentals exist across research projects. Below outlines the collective experience that qualitative researchers undertake to conduct research.

Step 1: Determine what to research

Once a researcher has determined a list of potential projects to tackle, they will prioritize projects based on the business's impact, available resourcing, timelines & dependencies to create a research roadmap. For each project, they will also identify the key questions they need to answer in the research.

The researcher should identify the participants they plan to research, and any key attributes that are a 'must-have' or 'nice to have' as these can be influential in determining the research approach (e.g. a niche group may require a longer timeline to recruit).

Researchers will generally aim for a mix of project types. Some may be more tactical or requests from stakeholders, and some will be projects that the researcher has proactively identified as opportunities for strategic research.

Step 2: Identify how to research it

Once the researcher has finalized the research project, they will need to figure out how they will do the work.

Firstly, the researcher will look through secondary data and research (e.g. analytics, previous research reports). Secondary analysis will help determine if there are existing answers to any of the open questions, ensuring that any net-new study doesn't duplicate current work (unless previous research is out of date).

After scoping the research, researchers will determine if the research input needs to be  attitudinal  (i.e. what someone says) or  behavioral  (i.e. what someone does); as well as if they need to  explore  a problem space or  evaluate  a product – these help determine the methodology to use. There are many methodologies out there, but the main ones you generally will find from a qualitative perspective are:

Interviews [Attitudinal / Exploratory]  – semi-structured conversation with a participant focused on a small set of topics. Runs for 30-60 minutes.

Contextual Inquiry [Behavioral / Exploratory]  – observation of a participant in their environment. Probing questions may be asked during the observation. Runs for 2-3 hours.

Survey [Attitudinal / Evaluative]  – gathering structured information from a sample of people, traditionally to generalize the results to a larger population. Surveys should generally not take participants more than 10 minutes to complete.

Usability Test [Behavioral / Evaluative]  – evaluating how representative users are, or are not, able to achieve critical tasks within an experience.

Check out these articles for more information about different methodologies:

When to Use Which User-Experience Research Methods

UX Research Cheat Sheet

Usability.gov

Design Research Kit

Step 3: Get buy-in and alignment from others

Once a researcher has determined what they will be researching and how they will research it, they will generally write up a research plan that includes additional information about the research goals, participant scope, timelines, and dependencies. The plan is typically either a document or presentation shared with stakeholders depending on the company and how they work.

After the research plan is complete, researchers will share the plan for feedback and input from their stakeholders to ensure that the stakeholders have the right expectations going into the research. Stakeholders may ask for additional question topics to be added, ensure that research will be executed against specific timelines, or provide recommendations on how the study will help make product decisions.

At organizations where there is a research team, researchers may also share their plan with other researchers informally or through a 'crit' process. Generally, researchers will provide feedback on the research craft, such as methodologies, participant mixes, and the research goals or questions.

Once the researcher feels confident in their plan, they will either begin to plan the research, or in the case of more junior researchers, get approval from their manager to begin the study.

Step 4: Prepare research

This step is where the researcher will get all of their ducks in a row to execute the research. Preparation activities include:

Equipment: Booking venues, labs, observation rooms, and procuring any appropriate equipment needed to run the study (e.g. cameras, mobile devices).

Participants: Sourcing participants from internal / external databases, reaching out/scheduling participants, managing schedule changes.

Incentives: Find budget, identify incentive type (e.g. Amazon gift card? customer credit? gift baskets), and purchasing.

Assets: Building relevant designs / prototypes (with design or design technologists), creating interview / observation guides and other research tools needed for sessions (e.g. physical cards for in-person card sorts).

Legal & Procurement: Participant waivers or NDAs preparation to ensure they are sent in advance of the research session to participants, vendor procurement, and management.

If Research Operations exists within an organization, they will generally take on most of the load in this area. The researcher will focus on assets required for executing research, such as interview guides.

In some cases, vendors may be engaged for some of these requirements (e.g. labs, participants, and incentive management) if resourcing is not available internally or if a researcher wants a blinded study (i.e. the participant doesn't know what company is running the research). In this case, additional time is incorporated to brief, onboard, and get approvals to work with the vendor.

Step 5: Execute research

Now the researcher gets to research!

Researchers will generally aim to execute research activities for 1–2 weeks, depending on the methodology to ensure they can be efficient in execution. In some more longitudinal methods (e.g., diary studies), or if a participant type is harder to recruit, it may take longer.

In consumer research, there will usually be back up participants available in case of no shows. However, in business or enterprise research, researchers will engage will all recruited participants as participants will generally have relationships with other parts of the company (e.g. sales). It is essential to maintain those relationships post-research.

During sessions, in a perfect world, there is one facilitator (principal researcher). In some cases, a secondary attendee who takes notes – this can be a stakeholder or a more junior researcher who can then learn soft skills from the primary researcher. By delegating note-taking, the principal researcher can focus on driving and managing the participant's conversation.

However, in most cases (especially if there is a "research team of one"), researchers will try to have to do both facilitation and documentation – this can lead to a clunkier conversation as the facilitator attempts to quickly write notes between trying to think of the next question. If a researcher decides to record a session instead, they will have to spend additional time after the research listening to the full recordings and writing notes.

In qualitative research, researchers may begin to  see patterns in the findings after five sessions . They may start to tailor the research questions to be more specific to gaps in their understanding.

Researchers may also set up an observation room for stakeholders (or share links to remote sessions) to attend live. Generally, researchers will have a backchannel (e.g., slack, chat, or SMS), so if a stakeholder has a follow-up question to an answer, the researcher can dig deeper. In some cases, researchers will give stakeholders an input form to take their notes that can be shared with the researcher afterward - this can be useful for the researcher to understand how the stakeholder views the research and what the stakeholder perceives as necessary to the research insights.

Step 6: Synthesize and find insights

Once the research capture is complete, the researcher will then aggregate findings to begin to look for common themes (in exploratory) or success rates (in evaluative). Both of these will then lead to insight generation that researchers will then look to tie back to the project's original research goals.

As analysis can be one of the most high-effort tasks in research, researchers will lean towards how to be efficient in their study, generally using digital tools, hacks, or workarounds. Researchers will usually create the analysis process they refine throughout their careers to help them become more efficient.

In cases where researchers are looking to get buy-in for research or capture stakeholder input, they may seem to more visual approaches (e.g. post-it affinity analysis) in war rooms. This process can take longer to process (especially if there is a high volume of data). Still, there can be a higher impact on analyzing research in this way – especially if the researcher is looking to get buy-in for future projects.

Step 7: Create research outputs

After a researcher identifies the key themes and insights, the researcher will reframe these findings to a relevant research output to ensure that stakeholders understand and buy-in to the outcomes. Outputs may include:

Report: Outlines vital findings from research in a document or presentation format. Will most likely include an executive summary, insight themes, and supporting evidence.

Videos: A highlight reel of supporting evidence from crucial findings. Generally seen as more useful and engaging compared to just a report. In most cases, the video will help the research report.

Personas : A written representation of a product's intended users to understand different types of user goals, needs, and behaviors. Also used to help stakeholders build empathy for the end-user of the product.

Journey Map : A visualization of the process that a person goes through to accomplish a goal. Generally created in conjunction with a persona.

Concepts / Wireframes / Designs: If research is evaluative, designs can visualize recommendations.

Storyboarding

Before a researcher makes the output, researchers will spend time planning the structure and storyboarding. Storyboarding is incredibly essential to help researchers define information requirements and ensure they present their findings in the most impactful way to stakeholders.

Having a point of view in outputs

Historically, researchers have tried to stay neutral to the data and not try to have a strong opinion or perspective to let the data speak. However, as researchers become more embedded in the industry, this has shifted to stakeholders wanting a strong point of view or recommendations from researchers that can help other stakeholders (especially product managers and designers) decide the knowledge captured as part of the research.

Having a strong perspective helps researchers have a seat at the table and appear as a trusted advisor/partner in cross-functional settings.

Step 8: Share and follow up on findings

After the research outputs are complete, some researchers will do a "pre-share" or walkthrough with key stakeholders or potential detractors to the research. The purpose of these meetings is to align with stakeholders' expectations and find potential 'watch-outs' (things that may derail a presentation).

Researchers will generally have to share their findings out multiple times to different stakeholder groups and tailor them for each audience. For example, executive meetings will be more higher level than a meeting with a product manager.

After sharing, researchers will follow up with key stakeholders (especially those who provided input to the research) to confirm they understand the findings and identify next steps. Next steps may include incorporating results in product strategy documents, proposals / PRDs, or user stories to ensure that the recommendations or findings have been reflected or sourced.

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Home » Qualitative Research – Methods, Analysis Types and Guide

Qualitative Research – Methods, Analysis Types and Guide

Table of Contents

Qualitative Research

Qualitative research is a type of research methodology that focuses on exploring and understanding people’s beliefs, attitudes, behaviors, and experiences through the collection and analysis of non-numerical data. It seeks to answer research questions through the examination of subjective data, such as interviews, focus groups, observations, and textual analysis.

Qualitative research aims to uncover the meaning and significance of social phenomena, and it typically involves a more flexible and iterative approach to data collection and analysis compared to quantitative research. Qualitative research is often used in fields such as sociology, anthropology, psychology, and education.

Qualitative Research Methods

Qualitative Research Methods are as follows:

One-to-One Interview

This method involves conducting an interview with a single participant to gain a detailed understanding of their experiences, attitudes, and beliefs. One-to-one interviews can be conducted in-person, over the phone, or through video conferencing. The interviewer typically uses open-ended questions to encourage the participant to share their thoughts and feelings. One-to-one interviews are useful for gaining detailed insights into individual experiences.

Focus Groups

This method involves bringing together a group of people to discuss a specific topic in a structured setting. The focus group is led by a moderator who guides the discussion and encourages participants to share their thoughts and opinions. Focus groups are useful for generating ideas and insights, exploring social norms and attitudes, and understanding group dynamics.

Ethnographic Studies

This method involves immersing oneself in a culture or community to gain a deep understanding of its norms, beliefs, and practices. Ethnographic studies typically involve long-term fieldwork and observation, as well as interviews and document analysis. Ethnographic studies are useful for understanding the cultural context of social phenomena and for gaining a holistic understanding of complex social processes.

Text Analysis

This method involves analyzing written or spoken language to identify patterns and themes. Text analysis can be quantitative or qualitative. Qualitative text analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Text analysis is useful for understanding media messages, public discourse, and cultural trends.

This method involves an in-depth examination of a single person, group, or event to gain an understanding of complex phenomena. Case studies typically involve a combination of data collection methods, such as interviews, observations, and document analysis, to provide a comprehensive understanding of the case. Case studies are useful for exploring unique or rare cases, and for generating hypotheses for further research.

Process of Observation

This method involves systematically observing and recording behaviors and interactions in natural settings. The observer may take notes, use audio or video recordings, or use other methods to document what they see. Process of observation is useful for understanding social interactions, cultural practices, and the context in which behaviors occur.

Record Keeping

This method involves keeping detailed records of observations, interviews, and other data collected during the research process. Record keeping is essential for ensuring the accuracy and reliability of the data, and for providing a basis for analysis and interpretation.

This method involves collecting data from a large sample of participants through a structured questionnaire. Surveys can be conducted in person, over the phone, through mail, or online. Surveys are useful for collecting data on attitudes, beliefs, and behaviors, and for identifying patterns and trends in a population.

Qualitative data analysis is a process of turning unstructured data into meaningful insights. It involves extracting and organizing information from sources like interviews, focus groups, and surveys. The goal is to understand people’s attitudes, behaviors, and motivations

Qualitative Research Analysis Methods

Qualitative Research analysis methods involve a systematic approach to interpreting and making sense of the data collected in qualitative research. Here are some common qualitative data analysis methods:

Thematic Analysis

This method involves identifying patterns or themes in the data that are relevant to the research question. The researcher reviews the data, identifies keywords or phrases, and groups them into categories or themes. Thematic analysis is useful for identifying patterns across multiple data sources and for generating new insights into the research topic.

Content Analysis

This method involves analyzing the content of written or spoken language to identify key themes or concepts. Content analysis can be quantitative or qualitative. Qualitative content analysis involves close reading and interpretation of texts to identify recurring themes, concepts, and patterns. Content analysis is useful for identifying patterns in media messages, public discourse, and cultural trends.

Discourse Analysis

This method involves analyzing language to understand how it constructs meaning and shapes social interactions. Discourse analysis can involve a variety of methods, such as conversation analysis, critical discourse analysis, and narrative analysis. Discourse analysis is useful for understanding how language shapes social interactions, cultural norms, and power relationships.

Grounded Theory Analysis

This method involves developing a theory or explanation based on the data collected. Grounded theory analysis starts with the data and uses an iterative process of coding and analysis to identify patterns and themes in the data. The theory or explanation that emerges is grounded in the data, rather than preconceived hypotheses. Grounded theory analysis is useful for understanding complex social phenomena and for generating new theoretical insights.

Narrative Analysis

This method involves analyzing the stories or narratives that participants share to gain insights into their experiences, attitudes, and beliefs. Narrative analysis can involve a variety of methods, such as structural analysis, thematic analysis, and discourse analysis. Narrative analysis is useful for understanding how individuals construct their identities, make sense of their experiences, and communicate their values and beliefs.

Phenomenological Analysis

This method involves analyzing how individuals make sense of their experiences and the meanings they attach to them. Phenomenological analysis typically involves in-depth interviews with participants to explore their experiences in detail. Phenomenological analysis is useful for understanding subjective experiences and for developing a rich understanding of human consciousness.

Comparative Analysis

This method involves comparing and contrasting data across different cases or groups to identify similarities and differences. Comparative analysis can be used to identify patterns or themes that are common across multiple cases, as well as to identify unique or distinctive features of individual cases. Comparative analysis is useful for understanding how social phenomena vary across different contexts and groups.

Applications of Qualitative Research

Qualitative research has many applications across different fields and industries. Here are some examples of how qualitative research is used:

• Market Research: Qualitative research is often used in market research to understand consumer attitudes, behaviors, and preferences. Researchers conduct focus groups and one-on-one interviews with consumers to gather insights into their experiences and perceptions of products and services.
• Health Care: Qualitative research is used in health care to explore patient experiences and perspectives on health and illness. Researchers conduct in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education: Qualitative research is used in education to understand student experiences and to develop effective teaching strategies. Researchers conduct classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work : Qualitative research is used in social work to explore social problems and to develop interventions to address them. Researchers conduct in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : Qualitative research is used in anthropology to understand different cultures and societies. Researchers conduct ethnographic studies and observe and interview members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : Qualitative research is used in psychology to understand human behavior and mental processes. Researchers conduct in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy : Qualitative research is used in public policy to explore public attitudes and to inform policy decisions. Researchers conduct focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

How to Conduct Qualitative Research

Here are some general steps for conducting qualitative research:

• Identify your research question: Qualitative research starts with a research question or set of questions that you want to explore. This question should be focused and specific, but also broad enough to allow for exploration and discovery.
• Select your research design: There are different types of qualitative research designs, including ethnography, case study, grounded theory, and phenomenology. You should select a design that aligns with your research question and that will allow you to gather the data you need to answer your research question.
• Recruit participants: Once you have your research question and design, you need to recruit participants. The number of participants you need will depend on your research design and the scope of your research. You can recruit participants through advertisements, social media, or through personal networks.
• Collect data: There are different methods for collecting qualitative data, including interviews, focus groups, observation, and document analysis. You should select the method or methods that align with your research design and that will allow you to gather the data you need to answer your research question.
• Analyze data: Once you have collected your data, you need to analyze it. This involves reviewing your data, identifying patterns and themes, and developing codes to organize your data. You can use different software programs to help you analyze your data, or you can do it manually.
• Interpret data: Once you have analyzed your data, you need to interpret it. This involves making sense of the patterns and themes you have identified, and developing insights and conclusions that answer your research question. You should be guided by your research question and use your data to support your conclusions.
• Communicate results: Once you have interpreted your data, you need to communicate your results. This can be done through academic papers, presentations, or reports. You should be clear and concise in your communication, and use examples and quotes from your data to support your findings.

Examples of Qualitative Research

Here are some real-time examples of qualitative research:

• Customer Feedback: A company may conduct qualitative research to understand the feedback and experiences of its customers. This may involve conducting focus groups or one-on-one interviews with customers to gather insights into their attitudes, behaviors, and preferences.
• Healthcare : A healthcare provider may conduct qualitative research to explore patient experiences and perspectives on health and illness. This may involve conducting in-depth interviews with patients and their families to gather information on their experiences with different health care providers and treatments.
• Education : An educational institution may conduct qualitative research to understand student experiences and to develop effective teaching strategies. This may involve conducting classroom observations and interviews with students and teachers to gather insights into classroom dynamics and instructional practices.
• Social Work: A social worker may conduct qualitative research to explore social problems and to develop interventions to address them. This may involve conducting in-depth interviews with individuals and families to understand their experiences with poverty, discrimination, and other social problems.
• Anthropology : An anthropologist may conduct qualitative research to understand different cultures and societies. This may involve conducting ethnographic studies and observing and interviewing members of different cultural groups to gain insights into their beliefs, practices, and social structures.
• Psychology : A psychologist may conduct qualitative research to understand human behavior and mental processes. This may involve conducting in-depth interviews with individuals to explore their thoughts, feelings, and experiences.
• Public Policy: A government agency or non-profit organization may conduct qualitative research to explore public attitudes and to inform policy decisions. This may involve conducting focus groups and one-on-one interviews with members of the public to gather insights into their perspectives on different policy issues.

Purpose of Qualitative Research

The purpose of qualitative research is to explore and understand the subjective experiences, behaviors, and perspectives of individuals or groups in a particular context. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research aims to provide in-depth, descriptive information that can help researchers develop insights and theories about complex social phenomena.

Qualitative research can serve multiple purposes, including:

• Exploring new or emerging phenomena : Qualitative research can be useful for exploring new or emerging phenomena, such as new technologies or social trends. This type of research can help researchers develop a deeper understanding of these phenomena and identify potential areas for further study.
• Understanding complex social phenomena : Qualitative research can be useful for exploring complex social phenomena, such as cultural beliefs, social norms, or political processes. This type of research can help researchers develop a more nuanced understanding of these phenomena and identify factors that may influence them.
• Generating new theories or hypotheses: Qualitative research can be useful for generating new theories or hypotheses about social phenomena. By gathering rich, detailed data about individuals’ experiences and perspectives, researchers can develop insights that may challenge existing theories or lead to new lines of inquiry.
• Providing context for quantitative data: Qualitative research can be useful for providing context for quantitative data. By gathering qualitative data alongside quantitative data, researchers can develop a more complete understanding of complex social phenomena and identify potential explanations for quantitative findings.

When to use Qualitative Research

Here are some situations where qualitative research may be appropriate:

• Exploring a new area: If little is known about a particular topic, qualitative research can help to identify key issues, generate hypotheses, and develop new theories.
• Understanding complex phenomena: Qualitative research can be used to investigate complex social, cultural, or organizational phenomena that are difficult to measure quantitatively.
• Investigating subjective experiences: Qualitative research is particularly useful for investigating the subjective experiences of individuals or groups, such as their attitudes, beliefs, values, or emotions.
• Conducting formative research: Qualitative research can be used in the early stages of a research project to develop research questions, identify potential research participants, and refine research methods.
• Evaluating interventions or programs: Qualitative research can be used to evaluate the effectiveness of interventions or programs by collecting data on participants’ experiences, attitudes, and behaviors.

Characteristics of Qualitative Research

Qualitative research is characterized by several key features, including:

• Focus on subjective experience: Qualitative research is concerned with understanding the subjective experiences, beliefs, and perspectives of individuals or groups in a particular context. Researchers aim to explore the meanings that people attach to their experiences and to understand the social and cultural factors that shape these meanings.
• Use of open-ended questions: Qualitative research relies on open-ended questions that allow participants to provide detailed, in-depth responses. Researchers seek to elicit rich, descriptive data that can provide insights into participants’ experiences and perspectives.
• Sampling-based on purpose and diversity: Qualitative research often involves purposive sampling, in which participants are selected based on specific criteria related to the research question. Researchers may also seek to include participants with diverse experiences and perspectives to capture a range of viewpoints.
• Data collection through multiple methods: Qualitative research typically involves the use of multiple data collection methods, such as in-depth interviews, focus groups, and observation. This allows researchers to gather rich, detailed data from multiple sources, which can provide a more complete picture of participants’ experiences and perspectives.
• Inductive data analysis: Qualitative research relies on inductive data analysis, in which researchers develop theories and insights based on the data rather than testing pre-existing hypotheses. Researchers use coding and thematic analysis to identify patterns and themes in the data and to develop theories and explanations based on these patterns.
• Emphasis on researcher reflexivity: Qualitative research recognizes the importance of the researcher’s role in shaping the research process and outcomes. Researchers are encouraged to reflect on their own biases and assumptions and to be transparent about their role in the research process.

Advantages of Qualitative Research

Qualitative research offers several advantages over other research methods, including:

• Depth and detail: Qualitative research allows researchers to gather rich, detailed data that provides a deeper understanding of complex social phenomena. Through in-depth interviews, focus groups, and observation, researchers can gather detailed information about participants’ experiences and perspectives that may be missed by other research methods.
• Flexibility : Qualitative research is a flexible approach that allows researchers to adapt their methods to the research question and context. Researchers can adjust their research methods in real-time to gather more information or explore unexpected findings.
• Contextual understanding: Qualitative research is well-suited to exploring the social and cultural context in which individuals or groups are situated. Researchers can gather information about cultural norms, social structures, and historical events that may influence participants’ experiences and perspectives.
• Participant perspective : Qualitative research prioritizes the perspective of participants, allowing researchers to explore subjective experiences and understand the meanings that participants attach to their experiences.
• Theory development: Qualitative research can contribute to the development of new theories and insights about complex social phenomena. By gathering rich, detailed data and using inductive data analysis, researchers can develop new theories and explanations that may challenge existing understandings.
• Validity : Qualitative research can offer high validity by using multiple data collection methods, purposive and diverse sampling, and researcher reflexivity. This can help ensure that findings are credible and trustworthy.

Limitations of Qualitative Research

Qualitative research also has some limitations, including:

• Subjectivity : Qualitative research relies on the subjective interpretation of researchers, which can introduce bias into the research process. The researcher’s perspective, beliefs, and experiences can influence the way data is collected, analyzed, and interpreted.
• Limited generalizability: Qualitative research typically involves small, purposive samples that may not be representative of larger populations. This limits the generalizability of findings to other contexts or populations.
• Time-consuming: Qualitative research can be a time-consuming process, requiring significant resources for data collection, analysis, and interpretation.
• Resource-intensive: Qualitative research may require more resources than other research methods, including specialized training for researchers, specialized software for data analysis, and transcription services.
• Limited reliability: Qualitative research may be less reliable than quantitative research, as it relies on the subjective interpretation of researchers. This can make it difficult to replicate findings or compare results across different studies.
• Ethics and confidentiality: Qualitative research involves collecting sensitive information from participants, which raises ethical concerns about confidentiality and informed consent. Researchers must take care to protect the privacy and confidentiality of participants and obtain informed consent.

Also see Research Methods

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Qualitative Research : Definition

Qualitative research is the naturalistic study of social meanings and processes, using interviews, observations, and the analysis of texts and images.  In contrast to quantitative researchers, whose statistical methods enable broad generalizations about populations (for example, comparisons of the percentages of U.S. demographic groups who vote in particular ways), qualitative researchers use in-depth studies of the social world to analyze how and why groups think and act in particular ways (for instance, case studies of the experiences that shape political views).   

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on 4 April 2022 by Pritha Bhandari . Revised on 30 January 2023.

Qualitative research involves collecting and analysing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analysing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, and history.

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Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography, action research, phenomenological research, and narrative research. They share some similarities, but emphasise different aims and perspectives.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

• Observations: recording what you have seen, heard, or encountered in detailed field notes.
• Interviews:  personally asking people questions in one-on-one conversations.
• Focus groups: asking questions and generating discussion among a group of people.
• Surveys : distributing questionnaires with open-ended questions.
• Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
• You take field notes with observations and reflect on your own experiences of the company culture.
• You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
• You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves ‘instruments’ in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analysing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

• Prepare and organise your data. This may mean transcribing interviews or typing up fieldnotes.
• Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
• Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorise your data.
• Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
• Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analysing qualitative data. Although these methods share similar processes, they emphasise different concepts.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

• Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

• Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

• Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

• Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

Researchers must consider practical and theoretical limitations in analysing and interpreting their data. Qualitative research suffers from:

• Unreliability

The real-world setting often makes qualitative research unreliable because of uncontrolled factors that affect the data.

• Subjectivity

Due to the researcher’s primary role in analysing and interpreting data, qualitative research cannot be replicated . The researcher decides what is important and what is irrelevant in data analysis, so interpretations of the same data can vary greatly.

• Limited generalisability

Small samples are often used to gather detailed data about specific contexts. Despite rigorous analysis procedures, it is difficult to draw generalisable conclusions because the data may be biased and unrepresentative of the wider population .

• Labour-intensive

Although software can be used to manage and record large amounts of text, data analysis often has to be checked or performed manually.

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to test a hypothesis by systematically collecting and analysing data, while qualitative methods allow you to explore ideas and experiences in depth.

There are five common approaches to qualitative research :

• Grounded theory involves collecting data in order to develop new theories.
• Ethnography involves immersing yourself in a group or organisation to understand its culture.
• Narrative research involves interpreting stories to understand how people make sense of their experiences and perceptions.
• Phenomenological research involves investigating phenomena through people’s lived experiences.
• Action research links theory and practice in several cycles to drive innovative changes.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organisations.

There are various approaches to qualitative data analysis , but they all share five steps in common:

• Prepare and organise your data.
• Review and explore your data.
• Develop a data coding system.
• Assign codes to the data.
• Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

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The word qualitative implies an emphasis on the qualities of entities and on processes and meanings that are not experimentally examined or measured [if measured at all] in terms of quantity, amount, intensity, or frequency. Qualitative researchers stress the socially constructed nature of reality, the intimate relationship between the researcher and what is studied, and the situational constraints that shape inquiry. Such researchers emphasize the value-laden nature of inquiry. They seek answers to questions that stress how social experience is created and given meaning. In contrast, quantitative studies emphasize the measurement and analysis of causal relationships between variables, not processes. Qualitative forms of inquiry are considered by many social and behavioral scientists to be as much a perspective on how to approach investigating a research problem as it is a method.

Denzin, Norman. K. and Yvonna S. Lincoln. “Introduction: The Discipline and Practice of Qualitative Research.” In The Sage Handbook of Qualitative Research . Norman. K. Denzin and Yvonna S. Lincoln, eds. 3 rd edition. (Thousand Oaks, CA: Sage, 2005), p. 10.

Characteristics of Qualitative Research

Below are the three key elements that define a qualitative research study and the applied forms each take in the investigation of a research problem.

• Naturalistic -- refers to studying real-world situations as they unfold naturally; non-manipulative and non-controlling; the researcher is open to whatever emerges [i.e., there is a lack of predetermined constraints on findings].
• Emergent -- acceptance of adapting inquiry as understanding deepens and/or situations change; the researcher avoids rigid designs that eliminate responding to opportunities to pursue new paths of discovery as they emerge.
• Purposeful -- cases for study [e.g., people, organizations, communities, cultures, events, critical incidences] are selected because they are “information rich” and illuminative. That is, they offer useful manifestations of the phenomenon of interest; sampling is aimed at insight about the phenomenon, not empirical generalization derived from a sample and applied to a population.

The Collection of Data

• Data -- observations yield a detailed, "thick description" [in-depth understanding]; interviews capture direct quotations about people’s personal perspectives and lived experiences; often derived from carefully conducted case studies and review of material culture.
• Personal experience and engagement -- researcher has direct contact with and gets close to the people, situation, and phenomenon under investigation; the researcher’s personal experiences and insights are an important part of the inquiry and critical to understanding the phenomenon.
• Empathic neutrality -- an empathic stance in working with study respondents seeks vicarious understanding without judgment [neutrality] by showing openness, sensitivity, respect, awareness, and responsiveness; in observation, it means being fully present [mindfulness].
• Dynamic systems -- there is attention to process; assumes change is ongoing, whether the focus is on an individual, an organization, a community, or an entire culture, therefore, the researcher is mindful of and attentive to system and situational dynamics.

The Analysis

• Unique case orientation -- assumes that each case is special and unique; the first level of analysis is being true to, respecting, and capturing the details of the individual cases being studied; cross-case analysis follows from and depends upon the quality of individual case studies.
• Inductive analysis -- immersion in the details and specifics of the data to discover important patterns, themes, and inter-relationships; begins by exploring, then confirming findings, guided by analytical principles rather than rules.
• Holistic perspective -- the whole phenomenon under study is understood as a complex system that is more than the sum of its parts; the focus is on complex interdependencies and system dynamics that cannot be reduced in any meaningful way to linear, cause and effect relationships and/or a few discrete variables.
• Context sensitive -- places findings in a social, historical, and temporal context; researcher is careful about [even dubious of] the possibility or meaningfulness of generalizations across time and space; emphasizes careful comparative case study analysis and extrapolating patterns for possible transferability and adaptation in new settings.
• Voice, perspective, and reflexivity -- the qualitative methodologist owns and is reflective about her or his own voice and perspective; a credible voice conveys authenticity and trustworthiness; complete objectivity being impossible and pure subjectivity undermining credibility, the researcher's focus reflects a balance between understanding and depicting the world authentically in all its complexity and of being self-analytical, politically aware, and reflexive in consciousness.

Berg, Bruce Lawrence. Qualitative Research Methods for the Social Sciences . 8th edition. Boston, MA: Allyn and Bacon, 2012; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 2nd ed. Thousand Oaks, CA: Sage Publications, 1995; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Basic Research Design for Qualitative Studies

Unlike positivist or experimental research that utilizes a linear and one-directional sequence of design steps, there is considerable variation in how a qualitative research study is organized. In general, qualitative researchers attempt to describe and interpret human behavior based primarily on the words of selected individuals [a.k.a., “informants” or “respondents”] and/or through the interpretation of their material culture or occupied space. There is a reflexive process underpinning every stage of a qualitative study to ensure that researcher biases, presuppositions, and interpretations are clearly evident, thus ensuring that the reader is better able to interpret the overall validity of the research. According to Maxwell (2009), there are five, not necessarily ordered or sequential, components in qualitative research designs. How they are presented depends upon the research philosophy and theoretical framework of the study, the methods chosen, and the general assumptions underpinning the study. Goals Describe the central research problem being addressed but avoid describing any anticipated outcomes. Questions to ask yourself are: Why is your study worth doing? What issues do you want to clarify, and what practices and policies do you want it to influence? Why do you want to conduct this study, and why should the reader care about the results? Conceptual Framework Questions to ask yourself are: What do you think is going on with the issues, settings, or people you plan to study? What theories, beliefs, and prior research findings will guide or inform your research, and what literature, preliminary studies, and personal experiences will you draw upon for understanding the people or issues you are studying? Note to not only report the results of other studies in your review of the literature, but note the methods used as well. If appropriate, describe why earlier studies using quantitative methods were inadequate in addressing the research problem. Research Questions Usually there is a research problem that frames your qualitative study and that influences your decision about what methods to use, but qualitative designs generally lack an accompanying hypothesis or set of assumptions because the findings are emergent and unpredictable. In this context, more specific research questions are generally the result of an interactive design process rather than the starting point for that process. Questions to ask yourself are: What do you specifically want to learn or understand by conducting this study? What do you not know about the things you are studying that you want to learn? What questions will your research attempt to answer, and how are these questions related to one another? Methods Structured approaches to applying a method or methods to your study help to ensure that there is comparability of data across sources and researchers and, thus, they can be useful in answering questions that deal with differences between phenomena and the explanation for these differences [variance questions]. An unstructured approach allows the researcher to focus on the particular phenomena studied. This facilitates an understanding of the processes that led to specific outcomes, trading generalizability and comparability for internal validity and contextual and evaluative understanding. Questions to ask yourself are: What will you actually do in conducting this study? What approaches and techniques will you use to collect and analyze your data, and how do these constitute an integrated strategy? Validity In contrast to quantitative studies where the goal is to design, in advance, “controls” such as formal comparisons, sampling strategies, or statistical manipulations to address anticipated and unanticipated threats to validity, qualitative researchers must attempt to rule out most threats to validity after the research has begun by relying on evidence collected during the research process itself in order to effectively argue that any alternative explanations for a phenomenon are implausible. Questions to ask yourself are: How might your results and conclusions be wrong? What are the plausible alternative interpretations and validity threats to these, and how will you deal with these? How can the data that you have, or that you could potentially collect, support or challenge your ideas about what’s going on? Why should we believe your results? Conclusion Although Maxwell does not mention a conclusion as one of the components of a qualitative research design, you should formally conclude your study. Briefly reiterate the goals of your study and the ways in which your research addressed them. Discuss the benefits of your study and how stakeholders can use your results. Also, note the limitations of your study and, if appropriate, place them in the context of areas in need of further research.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Heath, A. W. The Proposal in Qualitative Research. The Qualitative Report 3 (March 1997); Marshall, Catherine and Gretchen B. Rossman. Designing Qualitative Research . 3rd edition. Thousand Oaks, CA: Sage, 1999; Maxwell, Joseph A. "Designing a Qualitative Study." In The SAGE Handbook of Applied Social Research Methods . Leonard Bickman and Debra J. Rog, eds. 2nd ed. (Thousand Oaks, CA: Sage, 2009), p. 214-253; Qualitative Research Methods. Writing@CSU. Colorado State University; Yin, Robert K. Qualitative Research from Start to Finish . 2nd edition. New York: Guilford, 2015.

Strengths of Using Qualitative Methods

The advantage of using qualitative methods is that they generate rich, detailed data that leave the participants' perspectives intact and provide multiple contexts for understanding the phenomenon under study. In this way, qualitative research can be used to vividly demonstrate phenomena or to conduct cross-case comparisons and analysis of individuals or groups.

Among the specific strengths of using qualitative methods to study social science research problems is the ability to:

• Obtain a more realistic view of the lived world that cannot be understood or experienced in numerical data and statistical analysis;
• Provide the researcher with the perspective of the participants of the study through immersion in a culture or situation and as a result of direct interaction with them;
• Allow the researcher to describe existing phenomena and current situations;
• Develop flexible ways to perform data collection, subsequent analysis, and interpretation of collected information;
• Yield results that can be helpful in pioneering new ways of understanding;
• Respond to changes that occur while conducting the study ]e.g., extended fieldwork or observation] and offer the flexibility to shift the focus of the research as a result;
• Provide a holistic view of the phenomena under investigation;
• Respond to local situations, conditions, and needs of participants;
• Interact with the research subjects in their own language and on their own terms; and,
• Create a descriptive capability based on primary and unstructured data.

Anderson, Claire. “Presenting and Evaluating Qualitative Research.” American Journal of Pharmaceutical Education 74 (2010): 1-7; Denzin, Norman. K. and Yvonna S. Lincoln. Handbook of Qualitative Research . 2nd edition. Thousand Oaks, CA: Sage, 2000; Merriam, Sharan B. Qualitative Research: A Guide to Design and Implementation . San Francisco, CA: Jossey-Bass, 2009.

Limitations of Using Qualitative Methods

It is very much true that most of the limitations you find in using qualitative research techniques also reflect their inherent strengths . For example, small sample sizes help you investigate research problems in a comprehensive and in-depth manner. However, small sample sizes undermine opportunities to draw useful generalizations from, or to make broad policy recommendations based upon, the findings. Additionally, as the primary instrument of investigation, qualitative researchers are often embedded in the cultures and experiences of others. However, cultural embeddedness increases the opportunity for bias generated from conscious or unconscious assumptions about the study setting to enter into how data is gathered, interpreted, and reported.

Some specific limitations associated with using qualitative methods to study research problems in the social sciences include the following:

• Drifting away from the original objectives of the study in response to the changing nature of the context under which the research is conducted;
• Arriving at different conclusions based on the same information depending on the personal characteristics of the researcher;
• Replication of a study is very difficult;
• Research using human subjects increases the chance of ethical dilemmas that undermine the overall validity of the study;
• An inability to investigate causality between different research phenomena;
• Difficulty in explaining differences in the quality and quantity of information obtained from different respondents and arriving at different, non-consistent conclusions;
• Data gathering and analysis is often time consuming and/or expensive;
• Requires a high level of experience from the researcher to obtain the targeted information from the respondent;
• May lack consistency and reliability because the researcher can employ different probing techniques and the respondent can choose to tell some particular stories and ignore others; and,
• Generation of a significant amount of data that cannot be randomized into manageable parts for analysis.

Research Tip

Human Subject Research and Institutional Review Board Approval

Almost every socio-behavioral study requires you to submit your proposed research plan to an Institutional Review Board. The role of the Board is to evaluate your research proposal and determine whether it will be conducted ethically and under the regulations, institutional polices, and Code of Ethics set forth by the university. The purpose of the review is to protect the rights and welfare of individuals participating in your study. The review is intended to ensure equitable selection of respondents, that you have met the requirements for obtaining informed consent , that there is clear assessment and minimization of risks to participants and to the university [read: no lawsuits!], and that privacy and confidentiality are maintained throughout the research process and beyond. Go to the USC IRB website for detailed information and templates of forms you need to submit before you can proceed. If you are  unsure whether your study is subject to IRB review, consult with your professor or academic advisor.

Chenail, Ronald J. Introduction to Qualitative Research Design. Nova Southeastern University; Labaree, Robert V. "Working Successfully with Your Institutional Review Board: Practical Advice for Academic Librarians." College and Research Libraries News 71 (April 2010): 190-193.

Another Research Tip

Finding Examples of How to Apply Different Types of Research Methods

SAGE publications is a major publisher of studies about how to design and conduct research in the social and behavioral sciences. Their SAGE Research Methods Online and Cases database includes contents from books, articles, encyclopedias, handbooks, and videos covering social science research design and methods including the complete Little Green Book Series of Quantitative Applications in the Social Sciences and the Little Blue Book Series of Qualitative Research techniques. The database also includes case studies outlining the research methods used in real research projects. This is an excellent source for finding definitions of key terms and descriptions of research design and practice, techniques of data gathering, analysis, and reporting, and information about theories of research [e.g., grounded theory]. The database covers both qualitative and quantitative research methods as well as mixed methods approaches to conducting research.

SAGE Research Methods Online and Cases

NOTE :  For a list of online communities, research centers, indispensable learning resources, and personal websites of leading qualitative researchers, GO HERE .

For a list of scholarly journals devoted to the study and application of qualitative research methods, GO HERE .

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What is qualitative research?

Qualitative research is a process of naturalistic inquiry that seeks an in-depth understanding of social phenomena within their natural setting. It focuses on the "why" rather than the "what" of social phenomena and relies on the direct experiences of human beings as meaning-making agents in their every day lives. Rather than by logical and statistical procedures, qualitative researchers use multiple systems of inquiry for the study of human phenomena including biography, case study, historical analysis, discourse analysis, ethnography, grounded theory, and phenomenology.

University of Utah College of Nursing, (n.d.). What is qualitative research? [Guide] Retrieved from  https://nursing.utah.edu/research/qualitative-research/what-is-qualitative-research.php#what 

The following video will explain the fundamentals of qualitative research.

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Qualitative Data Coding

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

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Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Coding is the process of analyzing qualitative data (usually text) by assigning labels (codes) to chunks of data that capture their essence or meaning. It allows you to condense, organize and interpret your data.

A code is a word or brief phrase that captures the essence of why you think a particular bit of data may be useful. A good analogy is that a code describes data like a hashtag describes a tweet.

Coding is an iterative process, with researchers refining and revising their codes as their understanding of the data evolves.

The ultimate goal is to develop a coherent and meaningful coding scheme that captures the richness and complexity of the participants’ experiences and helps answer the research questions.

Step 1: Familiarize yourself with the data

• Read through your data (interview transcripts, field notes, documents, etc.) several times. This process is called immersion.
• Think and reflect on what may be important in the data before making any firm decisions about ideas, or potential patterns.

Step 2: Decide on your coding approach

• Will you use predefined deductive codes (based on theory or prior research), or let codes emerge from the data (inductive coding)?
• Will a piece of data have one code or multiple?
• Will you code everything or selectively? Broader research questions may warrant coding more comprehensively.

If you decide not to code everything, it’s crucial to:

• Have clear criteria for what you will and won’t code
• Be transparent about your selection process in research reports
• Remain open to revisiting uncoded data later in analysis

Step 3: Do a first round of coding

• Go through the data and assign initial codes to chunks that stand out
• Create a code name (a word or short phrase) that captures the essence of each chunk
• Keep a codebook – a list of your codes with descriptions or definitions
• Be open to adding, revising or combining codes as you go

Descriptive codes

• In vivo coding / Semantic coding : This method uses words or short phrases directly from the participant’s own language as codes. It deals with the surface-level content, labeling what participants directly say or describe. It identifies keywords, phrases, or sentences that capture the literal content. Participant : “I was just so overwhelmed with everything.” Code : “overwhelmed”
• Process coding : Uses gerunds (“-ing” words) to connote observable or conceptual action in the data. Participant : “I started by brainstorming ideas, then I narrowed them down.” Codes : “brainstorming ideas,” “narrowing down”
• Open coding : A form of initial coding where the researcher remains open to any possible theoretical directions indicated by the data. Participant : “I found the class really challenging, but I learned a lot.” Codes : “challenging class,” “learning experience”
• Descriptive coding : Summarizes the primary topic of a passage in a word or short phrase. Participant : “I usually study in the library because it’s quiet.” Code : “study environment”

Step 4: Review and refine codes

• Look over your initial codes and see if any can be combined, split up, or revised
• Ensure your code names clearly convey the meaning of the data
• Check if your codes are applied consistently across the dataset
• Get a second opinion from a peer or advisor if possible

Interpretive codes

Interpretive codes go beyond simple description and reflect the researcher’s understanding of the underlying meanings, experiences, or processes captured in the data.

These codes require the researcher to interpret the participants’ words and actions in light of the research questions and theoretical framework.

For example, latent coding is a type of interpretive coding which goes beyond surface meaning in data. It digs for underlying emotions, motivations, or unspoken ideas the participant might not explicitly state

Latent coding looks for subtext, interprets the “why” behind what’s said, and considers the context (e.g. cultural influences, or unconscious biases).

• Example: A participant might say, “Whenever I see a spider, I feel like I’m going to pass out. It takes me back to a bad experience as a kid.” A latent code here could be “Feelings of Panic Triggered by Spiders” because it goes beyond the surface fear and explores the emotional response and potential cause.

It’s useful to ask yourself the following questions:

• What are the assumptions made by the participants? 
• What emotions or feelings are expressed or implied in the data?
• How do participants relate to or interact with others in the data?
• How do the participants’ experiences or perspectives change over time?
• What is surprising, unexpected, or contradictory in the data?
• What is not being said or shown in the data? What are the silences or absences?

Theoretical codes

Theoretical codes are the most abstract and conceptual type of codes. They are used to link the data to existing theories or to develop new theoretical insights.

Theoretical codes often emerge later in the analysis process, as researchers begin to identify patterns and connections across the descriptive and interpretive codes.

• Structural coding : Applies a content-based phrase to a segment of data that relates to a specific research question. Research question : What motivates students to succeed? Participant : “I want to make my parents proud and be the first in my family to graduate college.” Interpretive Code : “family motivation” Theoretical code : “Social identity theory”
• Value coding : This method codes data according to the participants’ values, attitudes, and beliefs, representing their perspectives or worldviews. Participant : “I believe everyone deserves access to quality healthcare.” Interpretive Code : “healthcare access” (value) Theoretical code : “Distributive justice”

Pattern codes

Pattern coding is often used in the later stages of data analysis, after the researcher has thoroughly familiarized themselves with the data and identified initial descriptive and interpretive codes.

By identifying patterns and relationships across the data, pattern codes help to develop a more coherent and meaningful understanding of the phenomenon and can contribute to theory development or refinement.

For Example

Let’s say a researcher is studying the experiences of new mothers returning to work after maternity leave. They conduct interviews with several participants and initially use descriptive and interpretive codes to analyze the data. Some of these codes might include:

• “Guilt about leaving baby”
• “Struggle to balance work and family”
• “Support from colleagues”
• “Flexible work arrangements”
• “Breastfeeding challenges”

As the researcher reviews the coded data, they may notice that several of these codes relate to the broader theme of “work-family conflict.”

They might create a pattern code called “Navigating work-family conflict” that pulls together the various experiences and challenges described by the participants.

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Qualitative Research: Definition, Methodology, Limitation & Examples

Qualitative research is a method focused on understanding human behavior and experiences through non-numerical data. Examples of qualitative research include:

• One-on-one interviews,
• Focus groups, Ethnographic research,
• Case studies,
• Record keeping,
• Qualitative observations

In this article, we’ll provide tips and tricks on how to use qualitative research to better understand your audience through real world examples and improve your ROI. We’ll also learn the difference between qualitative and quantitative data.

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Marketers often seek to understand their customers deeply. Qualitative research methods such as face-to-face interviews, focus groups, and qualitative observations can provide valuable insights into your products, your market, and your customers’ opinions and motivations. Understanding these nuances can significantly enhance marketing strategies and overall customer satisfaction.

What is Qualitative Research

Qualitative research is a market research method that focuses on obtaining data through open-ended and conversational communication. This method focuses on the “why” rather than the “what” people think about you. Thus, qualitative research seeks to uncover the underlying motivations, attitudes, and beliefs that drive people’s actions. 

Let’s say you have an online shop catering to a general audience. You do a demographic analysis and you find out that most of your customers are male. Naturally, you will want to find out why women are not buying from you. And that’s what qualitative research will help you find out.

In the case of your online shop, qualitative research would involve reaching out to female non-customers through methods such as in-depth interviews or focus groups. These interactions provide a platform for women to express their thoughts, feelings, and concerns regarding your products or brand. Through qualitative analysis, you can uncover valuable insights into factors such as product preferences, user experience, brand perception, and barriers to purchase.

Types of Qualitative Research Methods

Qualitative research methods are designed in a manner that helps reveal the behavior and perception of a target audience regarding a particular topic.

The most frequently used qualitative analysis methods are one-on-one interviews, focus groups, ethnographic research, case study research, record keeping, and qualitative observation.

1. One-on-one interviews

Conducting one-on-one interviews is one of the most common qualitative research methods. One of the advantages of this method is that it provides a great opportunity to gather precise data about what people think and their motivations.

Spending time talking to customers not only helps marketers understand who their clients are, but also helps with customer care: clients love hearing from brands. This strengthens the relationship between a brand and its clients and paves the way for customer testimonials.

• A company might conduct interviews to understand why a product failed to meet sales expectations.
• A researcher might use interviews to gather personal stories about experiences with healthcare.

These interviews can be performed face-to-face or on the phone and usually last between half an hour to over two hours. 

When a one-on-one interview is conducted face-to-face, it also gives the marketer the opportunity to read the body language of the respondent and match the responses.

2. Focus groups

Focus groups gather a small number of people to discuss and provide feedback on a particular subject. The ideal size of a focus group is usually between five and eight participants. The size of focus groups should reflect the participants’ familiarity with the topic. For less important topics or when participants have little experience, a group of 10 can be effective. For more critical topics or when participants are more knowledgeable, a smaller group of five to six is preferable for deeper discussions.

The main goal of a focus group is to find answers to the “why”, “what”, and “how” questions. This method is highly effective in exploring people’s feelings and ideas in a social setting, where group dynamics can bring out insights that might not emerge in one-on-one situations.

• A focus group could be used to test reactions to a new product concept.
• Marketers might use focus groups to see how different demographic groups react to an advertising campaign.

One advantage that focus groups have is that the marketer doesn’t necessarily have to interact with the group in person. Nowadays focus groups can be sent as online qualitative surveys on various devices.

Focus groups are an expensive option compared to the other qualitative research methods, which is why they are typically used to explain complex processes.

3. Ethnographic research

Ethnographic research is the most in-depth observational method that studies individuals in their naturally occurring environment.

This method aims at understanding the cultures, challenges, motivations, and settings that occur.

• A study of workplace culture within a tech startup.
• Observational research in a remote village to understand local traditions.

Ethnographic research requires the marketer to adapt to the target audiences’ environments (a different organization, a different city, or even a remote location), which is why geographical constraints can be an issue while collecting data.

This type of research can last from a few days to a few years. It’s challenging and time-consuming and solely depends on the expertise of the marketer to be able to analyze, observe, and infer the data.

4. Case study research

The case study method has grown into a valuable qualitative research method. This type of research method is usually used in education or social sciences. It involves a comprehensive examination of a single instance or event, providing detailed insights into complex issues in real-life contexts.  

• Analyzing a single school’s innovative teaching method.
• A detailed study of a patient’s medical treatment over several years.

Case study research may seem difficult to operate, but it’s actually one of the simplest ways of conducting research as it involves a deep dive and thorough understanding of the data collection methods and inferring the data.

5. Record keeping

Record keeping is similar to going to the library: you go over books or any other reference material to collect relevant data. This method uses already existing reliable documents and similar sources of information as a data source.

• Historical research using old newspapers and letters.
• A study on policy changes over the years by examining government records.

This method is useful for constructing a historical context around a research topic or verifying other findings with documented evidence.

6. Qualitative observation

Qualitative observation is a method that uses subjective methodologies to gather systematic information or data. This method deals with the five major sensory organs and their functioning, sight, smell, touch, taste, and hearing.

• Sight : Observing the way customers visually interact with product displays in a store to understand their browsing behaviors and preferences.
• Smell : Noting reactions of consumers to different scents in a fragrance shop to study the impact of olfactory elements on product preference.
• Touch : Watching how individuals interact with different materials in a clothing store to assess the importance of texture in fabric selection.
• Taste : Evaluating reactions of participants in a taste test to identify flavor profiles that appeal to different demographic groups.
• Hearing : Documenting responses to changes in background music within a retail environment to determine its effect on shopping behavior and mood.

Below we are also providing real-life examples of qualitative research that demonstrate practical applications across various contexts:

Qualitative Research Real World Examples

Let’s explore some examples of how qualitative research can be applied in different contexts.

1. Online grocery shop with a predominantly male audience

Method used: one-on-one interviews.

Let’s go back to one of the previous examples. You have an online grocery shop. By nature, it addresses a general audience, but after you do a demographic analysis you find out that most of your customers are male.

One good method to determine why women are not buying from you is to hold one-on-one interviews with potential customers in the category.

Interviewing a sample of potential female customers should reveal why they don’t find your store appealing. The reasons could range from not stocking enough products for women to perhaps the store’s emphasis on heavy-duty tools and automotive products, for example. These insights can guide adjustments in inventory and marketing strategies.

2. Software company launching a new product

Method used: focus groups.

Focus groups are great for establishing product-market fit.

Let’s assume you are a software company that wants to launch a new product and you hold a focus group with 12 people. Although getting their feedback regarding users’ experience with the product is a good thing, this sample is too small to define how the entire market will react to your product.

So what you can do instead is holding multiple focus groups in 20 different geographic regions. Each region should be hosting a group of 12 for each market segment; you can even segment your audience based on age. This would be a better way to establish credibility in the feedback you receive.

3. Alan Pushkin’s “God’s Choice: The Total World of a Fundamentalist Christian School”

Method used: ethnographic research.

Moving from a fictional example to a real-life one, let’s analyze Alan Peshkin’s 1986 book “God’s Choice: The Total World of a Fundamentalist Christian School”.

Peshkin studied the culture of Bethany Baptist Academy by interviewing the students, parents, teachers, and members of the community alike, and spending eighteen months observing them to provide a comprehensive and in-depth analysis of Christian schooling as an alternative to public education.

The study highlights the school’s unified purpose, rigorous academic environment, and strong community support while also pointing out its lack of cultural diversity and openness to differing viewpoints. These insights are crucial for understanding how such educational settings operate and what they offer to students.

Even after discovering all this, Peshkin still presented the school in a positive light and stated that public schools have much to learn from such schools.

Peshkin’s in-depth research represents a qualitative study that uses observations and unstructured interviews, without any assumptions or hypotheses. He utilizes descriptive or non-quantifiable data on Bethany Baptist Academy specifically, without attempting to generalize the findings to other Christian schools.

4. Understanding buyers’ trends

Method used: record keeping.

Another way marketers can use quality research is to understand buyers’ trends. To do this, marketers need to look at historical data for both their company and their industry and identify where buyers are purchasing items in higher volumes.

For example, electronics distributors know that the holiday season is a peak market for sales while life insurance agents find that spring and summer wedding months are good seasons for targeting new clients.

5. Determining products/services missing from the market

Conducting your own research isn’t always necessary. If there are significant breakthroughs in your industry, you can use industry data and adapt it to your marketing needs.

The influx of hacking and hijacking of cloud-based information has made Internet security a topic of many industry reports lately. A software company could use these reports to better understand the problems its clients are facing.

As a result, the company can provide solutions prospects already know they need.

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Qualitative Research Approaches

Once the marketer has decided that their research questions will provide data that is qualitative in nature, the next step is to choose the appropriate qualitative approach.

The approach chosen will take into account the purpose of the research, the role of the researcher, the data collected, the method of data analysis , and how the results will be presented. The most common approaches include:

• Narrative : This method focuses on individual life stories to understand personal experiences and journeys. It examines how people structure their stories and the themes within them to explore human existence. For example, a narrative study might look at cancer survivors to understand their resilience and coping strategies.
• Phenomenology : attempts to understand or explain life experiences or phenomena; It aims to reveal the depth of human consciousness and perception, such as by studying the daily lives of those with chronic illnesses.
• Grounded theory : investigates the process, action, or interaction with the goal of developing a theory “grounded” in observations and empirical data. 
• Ethnography : describes and interprets an ethnic, cultural, or social group;
• Case study : examines episodic events in a definable framework, develops in-depth analyses of single or multiple cases, and generally explains “how”. An example might be studying a community health program to evaluate its success and impact.

How to Analyze Qualitative Data

Analyzing qualitative data involves interpreting non-numerical data to uncover patterns, themes, and deeper insights. This process is typically more subjective and requires a systematic approach to ensure reliability and validity. 

1. Data Collection

Ensure that your data collection methods (e.g., interviews, focus groups, observations) are well-documented and comprehensive. This step is crucial because the quality and depth of the data collected will significantly influence the analysis.

2. Data Preparation

Once collected, the data needs to be organized. Transcribe audio and video recordings, and gather all notes and documents. Ensure that all data is anonymized to protect participant confidentiality where necessary.

3. Familiarization

Immerse yourself in the data by reading through the materials multiple times. This helps you get a general sense of the information and begin identifying patterns or recurring themes.

Develop a coding system to tag data with labels that summarize and account for each piece of information. Codes can be words, phrases, or acronyms that represent how these segments relate to your research questions.

• Descriptive Coding : Summarize the primary topic of the data.
• In Vivo Coding : Use language and terms used by the participants themselves.
• Process Coding : Use gerunds (“-ing” words) to label the processes at play.
• Emotion Coding : Identify and record the emotions conveyed or experienced.

5. Thematic Development

Group codes into themes that represent larger patterns in the data. These themes should relate directly to the research questions and form a coherent narrative about the findings.

6. Interpreting the Data

Interpret the data by constructing a logical narrative. This involves piecing together the themes to explain larger insights about the data. Link the results back to your research objectives and existing literature to bolster your interpretations.

7. Validation

Check the reliability and validity of your findings by reviewing if the interpretations are supported by the data. This may involve revisiting the data multiple times or discussing the findings with colleagues or participants for validation.

8. Reporting

Finally, present the findings in a clear and organized manner. Use direct quotes and detailed descriptions to illustrate the themes and insights. The report should communicate the narrative you’ve built from your data, clearly linking your findings to your research questions.

Limitations of qualitative research

The disadvantages of qualitative research are quite unique. The techniques of the data collector and their own unique observations can alter the information in subtle ways. That being said, these are the qualitative research’s limitations:

1. It’s a time-consuming process

The main drawback of qualitative study is that the process is time-consuming. Another problem is that the interpretations are limited. Personal experience and knowledge influence observations and conclusions.

Thus, qualitative research might take several weeks or months. Also, since this process delves into personal interaction for data collection, discussions often tend to deviate from the main issue to be studied.

2. You can’t verify the results of qualitative research

Because qualitative research is open-ended, participants have more control over the content of the data collected. So the marketer is not able to verify the results objectively against the scenarios stated by the respondents. For example, in a focus group discussing a new product, participants might express their feelings about the design and functionality. However, these opinions are influenced by individual tastes and experiences, making it difficult to ascertain a universally applicable conclusion from these discussions.

3. It’s a labor-intensive approach

Qualitative research requires a labor-intensive analysis process such as categorization, recording, etc. Similarly, qualitative research requires well-experienced marketers to obtain the needed data from a group of respondents.

4. It’s difficult to investigate causality

Qualitative research requires thoughtful planning to ensure the obtained results are accurate. There is no way to analyze qualitative data mathematically. This type of research is based more on opinion and judgment rather than results. Because all qualitative studies are unique they are difficult to replicate.

5. Qualitative research is not statistically representative

Because qualitative research is a perspective-based method of research, the responses given are not measured.

Comparisons can be made and this can lead toward duplication, but for the most part, quantitative data is required for circumstances that need statistical representation and that is not part of the qualitative research process.

While doing a qualitative study, it’s important to cross-reference the data obtained with the quantitative data. By continuously surveying prospects and customers marketers can build a stronger database of useful information.

Quantitative vs. Qualitative Research

Image source

Quantitative and qualitative research are two distinct methodologies used in the field of market research, each offering unique insights and approaches to understanding consumer behavior and preferences.

As we already defined, qualitative analysis seeks to explore the deeper meanings, perceptions, and motivations behind human behavior through non-numerical data. On the other hand, quantitative research focuses on collecting and analyzing numerical data to identify patterns, trends, and statistical relationships.  

Let’s explore their key differences: 

Nature of Data:

• Quantitative research : Involves numerical data that can be measured and analyzed statistically.
• Qualitative research : Focuses on non-numerical data, such as words, images, and observations, to capture subjective experiences and meanings.

Research Questions:

• Quantitative research : Typically addresses questions related to “how many,” “how much,” or “to what extent,” aiming to quantify relationships and patterns.
• Qualitative research: Explores questions related to “why” and “how,” aiming to understand the underlying motivations, beliefs, and perceptions of individuals.

Data Collection Methods:

• Quantitative research : Relies on structured surveys, experiments, or observations with predefined variables and measures.
• Qualitative research : Utilizes open-ended interviews, focus groups, participant observations, and textual analysis to gather rich, contextually nuanced data.

Analysis Techniques:

• Quantitative research: Involves statistical analysis to identify correlations, associations, or differences between variables.
• Qualitative research: Employs thematic analysis, coding, and interpretation to uncover patterns, themes, and insights within qualitative data.

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Open Access

Peer-reviewed

Research Article

"You don’t get side effects from social prescribing”—A qualitative study exploring community pharmacists’ attitudes to social prescribing

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing

Roles Writing – review & editing

Affiliation Independent Research Pharmacist, United Kingdom

Roles Writing – original draft, Writing – review & editing

Affiliation Nuffield Department of Primary Care Science, University of Oxford, Oxford, United Kingdom

Roles Conceptualization, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing

Roles Formal analysis, Investigation, Methodology, Supervision, Writing – original draft, Writing – review & editing

• Adam Pattison Rathbone, 
• Harry Pearson, 
• Oluwafunmi Akinyemi, 
• Nia Cartwright, 
• Stephanie Tierney, 
• Gill Rowlands, 
• Laura Lindsey

• Published: May 16, 2024
• https://doi.org/10.1371/journal.pone.0301076
• Reader Comments

Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies.

Study design

A qualitative phenomenological approach was used.

A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed.

The sample included largely male pharmacists (63.3%) with less than five years’ experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team’s role to optimise health outcomes.

Conclusions

The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

Citation: Rathbone AP, Pearson H, Akinyemi O, Cartwright N, Tierney S, Rowlands G, et al. (2024) "You don’t get side effects from social prescribing”—A qualitative study exploring community pharmacists’ attitudes to social prescribing. PLoS ONE 19(5): e0301076. https://doi.org/10.1371/journal.pone.0301076

Editor: Simon White, Keele University, UNITED KINGDOM

Received: September 18, 2023; Accepted: March 9, 2024; Published: May 16, 2024

Copyright: © 2024 Rathbone et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: There are ethical and legal restrictions on sharing the de-identified data set. Participants did not give explicit consent for the de-identified data set to be shared as participants were told the data would be kept confidential. Anonymized data is held at an online repository under embargo. This restriction is imposed by the University Ethics Committee. Please contact [email protected] for further information.

Funding: The author(s0 received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Social prescribing has been described as: “ a means for health-care workers to connect patients to a range of non-clinical services in the community to improve health and well-being . Social prescribing can help to address the underlying causes of patients’ health and well-being issues , as opposed to simply treating symptoms .” [ 1 ]. It has become a cornerstone of healthcare policy in the UK [ 2 ] and overseas [ 3 ]. Patients are often referred for social prescribing by a General Practitioner (GP), who contacts a link worker to meet with the patient to identify appropriate support for their non-medical needs [ 3 ]. Exercise classes, arts and crafts, volunteering, gardening, and cookery classes, as well as accommodation and debt management services, are among the types of support patients might be connected to by a link worker [ 4 – 6 ].

It is argued that social prescribing can be useful for people living with long-term health conditions, mental health problems, socioeconomic struggles and social isolation–the latter of which has become more prevalent following the COVID-19 pandemic [ 7 ]. There is some evidence suggesting engagement in social prescribing may reduce demand for non-elective healthcare [ 8 ] and GP attendances [ 9 ]. Hence, it may be a means of addressing demand on overstretched healthcare services, supporting the broader well-being of vulnerable, socioeconomically disadvantaged communities. However, it should be noted, claims social prescribing reduces health inequalities for socioeconomically deprived communities are still considered contentious and their impact on reducing demand of some healthcare services, such as pharmacies, is not known [ 10 – 13 ].

Approaches to expanding access to social prescribing are being explored in the UK through ‘proactive social prescribing’ [ 14 ], where patient populations are screened by primary care professionals to identify target groups with unmet needs. Other examples of improving access to social prescribing are schemes such as digital self-referrals, where an app matches patients with appropriate support in the community [ 15 ]. In addition, an appeal for further healthcare professionals, including pharmacists, to take a role in social prescribing has been made [ 16 ].

Pharmacies offer open access to healthcare for a wide range of people, in both rural and urban settings. Pharmacies are known to be more accessible than GPs in areas of high socioeconomic deprivation [ 17 ]. Evidence suggests during the pandemic in the UK in 2020, over a third of patients visited their community pharmacy instead of their GP practice [ 18 ] although it was unclear if this prevented follow-up visits to GP practices. Although pharmacies are reporting high workloads [ 19 – 21 ], their accessibility makes them suitable for healthcare initiatives to reduce demand on existing health services [ 15 , 17 ]. Despite this, funding for pharmacies in the UK is focused primarily on dispensing medications rather than patient-facing services [ 22 ]. Recent changes to policy, such as the NHS Long Term Plan, Healthy Living Pharmacy Framework, Pharmacy First and the Community Pharmacy Consultation Scheme, indicate pharmacies will be an increasingly important place for the delivery of healthcare services, both urgent and preventative, in the future [ 2 , 23 – 26 ].

The evidence evaluating social prescribing interventions in pharmacy is limited. A systematic review in 2017 found little evidence of the efficacy of social prescribing in community settings, due to the short-term nature of the evaluations [ 27 ]. Other work focusing specifically on pharmacies found similarly limited literature [ 28 ]. To improve the existing evidence for social prescribing in pharmacy, evaluations must start from the foundations and work up; identifying capabilities, opportunities and motivations of pharmacy teams as well as the impact on patients, community groups and other health and social care professionals in the system. Little is known about pharmacists’ awareness and understanding of social prescribing and what factors influence their involvement in this non-clinical activity [ 28 , 29 ]. What evidence does exist suggests workload and funding may limit the involvement of pharmacists, and that these professionals may have limited awareness of what social prescribing is [ 29 ]. This existing evidence is based on quantitative methods and, thus, did not provide a detailed description of pharmacists’ experiences of social prescribing in practice. Hence, the aim of our study was to explore community pharmacists’ experiences, perspectives and attitudes to social prescribing in practice.

A qualitative phenomenological approach was adopted, which drew on the Capability Opportunity Motivation–Behaviour (COM-B) model [ 30 ]. A phenomenological approach allowed the study to focus on community pharmacists’ experiences of what happens in practice and how it happens [ 31 ]. Specifically, the COM-B model was used to create a topic guide to use during interviews and added structure to the findings following the identification of themes. As evidence in relation to pharmacists’ roles in social prescribing is limited, an exploratory design was appropriate [ 30 ].

Participants and recruitment

A convenience sampling method was adopted. A form was posted on social media (Twitter and Facebook) to allow participants to self-screen against inclusion criteria. The criteria included having experience working as a community pharmacist in Northern England, conversant in English, and capacity to consent to research. Snowball sampling was also used to recruit participants to the study.

The form was created and posted on social media via the research team (APR, HP, LL) outlining the study. Users completed screening questions for eligibility and were prompted to give an email address and telephone number to be contacted. The decision to limit to Northern England was pragmatic as researchers were based there. It also allowed the study to recruit pharmacists practicing in areas of high deprivation, where pharmacists are known to be more readily accessed by patients than in areas of low deprivation [ 17 ]. A participant information sheet was provided to interviewees in advance, and verbal consent was taken prior to participation, which was recorded by the interviewer (HP) and witnessed by the supervisor (APR).

Methods of data collection

Semi-structured interviews were conducted via the online platforms Zoom and Microsoft Teams, and over the telephone between Monday 5th October 2020 and Friday 29 th January 2021. The semi-structured nature of the interviews allowed for an in-depth exploration of pharmacists’ views, which would be unobtainable via a survey [ 32 ]. Interviews were conducted at a time convenient to the participant. Interviews lasted between 30 and 45 minutes (average = 39 minutes). A topic guide was used (see Tables 1 and 2 ) that included questions such as: i) What are your experiences of social prescribing? ii) What do you understand as the advantages of social prescribing in community pharmacy? iii) What do you think are the barriers to implementing social prescribing in community pharmacy?

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https://doi.org/10.1371/journal.pone.0301076.t001

https://doi.org/10.1371/journal.pone.0301076.t002

One-to-one interviews were conducted by a final year pharmacy student (HP). He was trained by experienced qualitative health researchers (LL, GR, APR). Interviews were audio-recorded and transcribed manually by one author (HP) with a 10% sample quality checked by listening back to the audio and reading the transcript (APR) [ 33 , 34 ]. Transcripts were anonymised by removing the names of participants, people, and places [ 33 , 34 ]. Data collection ceased at the point of theoretical data sufficiency [ 35 ], which occurred after ten interviews; one additional interview was conducted to confirm this was the case. Theoretical data sufficiency relates to the point in the study at which no new findings are being identified in the data. This was operationalised in the study through regular weekly supervision meetings during data collection and analysis to interrogate, explore and identify when no new findings were being found. This point indicates the research team had access to sufficient data to draw conclusions, though due to the nature of qualitative inquiry, further findings may be found by new researchers looking at the same data.

Data processing and analysis

Transcripts were imported into NVivo and inductive thematic analysis was completed by three researchers (HP, APR, LL) using the method outlined by Braun and Clarke (33). The first step of this analysis began with familiarisation with the data, next there was generation of initial codes, then clusters were created, and finally themes. A constant comparative approach was adopted, which meant codes, clusters and themes were compared with one another and findings interrogated in data presentation meetings involving the authors. This process was underpinned by a phenomenological understanding of experiences, which focuses on what the essence of an experience is and how this happens–i.e., what was happening and how was it happening. The COM-B Model was then used to contextualise the themes to link what happened to behavioural theory.

As part of the analysis, participants were categorised based on their role within community pharmacy and the length of time since registration. Participants with experience of less than five years were classified as ‘pharmacists with less experience’. This classification is in line with The Royal Pharmaceutical Society (RPS) Foundation Pharmacist Framework [ 36 ]. Participants with experience greater than this were categorised as ‘pharmacists with more experience’. This follows the RPS Advanced Pharmacy Framework [ 37 ]. Credibility was defined as the ability of the findings of the study to be reasonably believed and dependability was defined as the ability to trust the research process was carried out accurately. Credibility and dependability were established by involving more than one person in the analysis (sometimes referred to as analytical triangulation), through presentation and discussion of data at regular coding meetings with the research team. Weekly meetings were also used to ensure senior authors (LL, GR, APR) provided suitable training, support, supervision and accountability to the team (HP, NC). The study processes and findings were also reviewed by external collaborators (OA, ST) which further enhanced the credibility and dependability of the findings.

Reflexivity

Reflexivity allows research authors to become aware of, respond to and acknowledge how their own personal characteristics, identity and perspectives influences research [ 38 ]. In this study, the authors came from working class, middle class and upper middle-class backgrounds, where mostly White and came from Britain. Two authors were not from Britain and two authors were not White. Three authors were pharmacists, one was a general practitioner and one a psychologist. Four authors had completed, and one author was completing, a PhD. The research was led by a team based in a School of Pharmacy and this meant members of the research team may have been well known to participants as former educators (LL, APR) or colleagues (HP, OA). This meant there was a shared understanding of language and terminology between participants and researchers which enriched the subjectivity of the study during data collection. However, other members of the research team (NC, ST, GR) were less professionally connected to the pharmacy sector and so provided an objective perspective during data analysis and interpretation.

Research ethics

Ethical approval for this study was obtained through Newcastle University (reference number 6162/2020).

Participant demographics

Eleven participants were recruited and demographics are summarised in Table 1 .

Thematic findings

Findings are described below, with codes, clusters and themes shown in Table 2 . Data extracts describe findings in participants’ own words. Quotes denote if participants were employee, locum or owner pharmacists and which ‘type’ of pharmacy they worked in–either an ‘independent’ pharmacy which refers to a small chain, local, or single pharmacy business or a ‘multiple’ pharmacy chain which refers to a large, multi-national pharmacy corporation with many pharmacy businesses operating under a single banner.

Theme 1) Varied knowledge and understanding of social prescribing.

Most participants seemed to have an awareness of and enthusiasm for social prescribing, although they reported little knowledge of it. The setting where participants worked, their status or level of experience did not appear to influence knowledge or reported beliefs about social prescribing. Participants who were aware of social prescribing appeared to know about it either from involvement in a social prescribing event, through prescribing community-based, non-clinical support themselves, or having heard about the process in previous employment.

“ I was running group clinics…where we don’t just talk about their medicines, we talk about interventions like exercise, or lifestyle advice or diet. It was much more informal, but we would make recommendations to patients like a Tai Chi class for example, that you would benefit from, or you might be better off doing some core strengthening exercises given your type of arthritis.” Participant 6 (Pharmacist, Independent)

Despite a limited understanding, pharmacists appeared to believe they had capability to support social prescribing. However, they appeared to view it as a clinician-led approach, focusing on the physical symptoms of disease, rather than a person-centred approach to address socioeconomic factors of health and well-being, directed by the patient to address their specific needs. This indicated social prescribing was being conflated with public health promotion, lifestyle campaigns.

“ I can really see where [social prescribing] would fit in that remit, so the kind of physical and the recommendation for physical activity, how it can help with a number of different medical conditions… we’ve got a really good knowledge base of different health conditions and generally kind of how the body works. So why not use that and I don’t think we’re using it a lot at the minute.” Participant 1 (Locum, Independent)

These findings demonstrate the nuance of pharmacists’ approach to social prescribing, in that, enthusiasm toward social prescribing was reported, but that this appeared to be based on an understanding of social prescribing as an aspect of health promotion and lifestyle interventions based on physical disease states, rather than socio-economic circumstances of the patient.

Theme 2) Factors influencing involvement in social prescribing.

Concern about the economics of a pharmacy businesses, the balance of workload and funding, was a recurring factor which appeared to shape participants’ thoughts about involvement in social prescribing. Participants reported the busy nature of community pharmacy and highlighted how much additional time would be needed to engage with social prescribing.

“ Well with the increase of both dispensing items, the more and more consultations that we are having to do, as well as the fact some stores due to cuts [to funding] have had to get rid of managers, that then falls on the pharmacist’s desk, there’s a lot less time for patient-pharmacist discussions. So timing is going to be a major issue I think.” Participant 11 (Employee, Multiple)

Additional demands and additional time pressure, following on from the relentless experience encountered during the pandemic for many pharmacists through involvement in vaccination and increased workload, were concerns participants shared.

“ I certainly have worked over the COVID-19 pandemic in community myself, I know how ridiculously busy we’ve been. You know to try and fit in another additional service on top of all of the ones that are already being offered… but I think currently I’ve never known pharmacy this busy in my entire career…” Participant 6 (Employee, Independent)

Hesitancy also related to patients’ responses to being offered social prescribing in a pharmacy setting.

“ They might feel embarrassed to accept that help. And they might find it quite intrusive, they might not expect a pharmacist to be involved and…nobody wants to be categorised as a vulnerable or isolated patient particularly.” Participant 4 (Employee, Multiple)

Participants reported feeling that larger ‘multiples’ companies had greater resources and financial capital and would therefore find it easier to implement social prescribing services than independent organisations.

“ And the small pharmacies I worry that because they’re so, their [funding is] so tight they are trying to make the best they can being an independent that they won’t sort of have the capacity necessary to widen to some of these sorts of wider societal things that they can have input in.” Participant 5 (Employee, Multiple)

Conversely, others suggested larger organisations with more capital may focus on profits rather than supporting patient communities, unlike independent organisations.

“ I’ve worked for [supermarket pharmacy 1] and [supermarket pharmacy 2] before which are bigger companies, and I know they’re much more focused around [funding]…rather than the kind of community support and health advice [in social prescribing]. I think an independent might do it because of the benefit to the community and to be seen to be giving extra services which might attract and keep their customer base.” Participant 6 (Employee, Independent)

The only participant who was a pharmacy owner (and therefore responsible for organisational structure and financial targets of a community pharmacy business) reported social prescribing was an individual, professional decision of the pharmacist in charge, rather than the priorities of the business or owner. This appeared to diminish the role of organizational policy, working conditions (such as opening times and staffing levels), and the funding landscape, suggesting engagement with social prescribing will come down to personal preference of the individual pharmacist.

“ There’s no [funding] difference between the individual pharmacists, whoever they work for. So, under those circumstances it doesn’t matter if it’s an independent or a multiple pharmacy, they will organise themselves differently, but it’ll come down to the individuals, not the policy of the owner.” Participant 10 (Owner, Independent)

Collectively, these findings indicate pharmacists’ motivations to deliver social prescribing services are influenced by access to appropriate levels of economic capital and resources to manage workload and patient expectations.

Theme 3) Outcomes of social prescribing in community pharmacy.

This theme describes social prescribing as an opportunity for pharmacies to improve patient outcomes by involving all members of the pharmacy team, not just pharmacists. The inclusion of all staff into social prescribing was raised by participants. The knowledge and trust shared with patients was considered to make them a good resource to facilitate social prescribing. Participants felt dispensing staff, delivery drivers, and pharmacy technicians, as well as pharmacists, represented valuable assets to facilitate social prescribing, if given appropriate training and links to social prescribing networks.

Participants appeared to clearly understand the accessibility of pharmacy and highlighted the patient-centeredness of pharmacies, in comparison to other healthcare settings for patients, was aligned to social prescribing principles.

“ We are the most accessible healthcare professional in every community, and patients know they can just pop in for that source of advice. We have a lot more time [than other healthcare professionals] to tailor to individual patients” Participant 11 (Employee, Multiple)

Participants reported valuing the role that social prescribing could play in improving health outcomes for patients, lessening the need for medication and expensive treatments.

“ …you’ve got the obvious benefits to the patients around outcomes…it might be that they are prescribed metformin for type 2 diabetes, which alongside social prescribing around diet and exercise…as a result of the diet and exercise intervention that the whole…type 2 diabetes will be better off.” Participant 5 (Employee, Multiple)

Additionally, participants appeared to recognise opportunities to improve patient care by providing an alternative to medications.

“ You know it’s got loads of benefits for patients because you know you don’t get side effects from social prescribing.” Participant 6 (Employee, Independent)

Pharmacistsreported the need to work with others who are already social prescribing to learn, share best practice and develop a common understanding.

“ Ultimately though this isn’t something pharmacies could just do on their own, we need to be linked up with other people doing this, like is there a national body of social prescribers or like standardised training about how to do it? If we knew more about social prescribers we would be linked in with that network more.” Participant 10 (Owner, Independent)

Collectively this theme demonstrates complexity in pharmacists’ views of the outcomes of social prescribing, primarily being reliant on the social capital pharmacists have with patients and other staff in their premises but also on building social capital by engaging with other social prescribing networks and experts.

Discussion and conclusion

Summary of findings.

The key finding of this study is participants appeared to recognise, understand and value social prescribing as a means of supporting patients’ health and well-being, but misunderstood social prescribing as a form of disease-focused, public health promotion. Limited training, experience and resources to facilitate social prescribing in practice were identified as learning needs in this study. Participants reported willing to be involved in social prescribing, reporting interests to better understand the process of social prescribing and expressing beliefs that this could expand the current role of community pharmacists and their team members. Many participants reported limited exposure to or involvement with social prescribing in current practice and education. This indicates a need for further collaboration and involvement in social prescribing networks. Professional bodies may also need to support education, learning and training of pharmacists and their teams to implement social prescribing services. The unique accessibility of community pharmacy teams and the rapport they have with their patients were seen as opportunities to contribute to social prescribing to improve patient outcomes.

A strength of the study is it provides a conceptualization of pharmacists’ understanding of social prescribing. The study met theoretical data sufficiency and used qualitative methods to identify insights. Additionally, the sample included pharmacists from a range of practice settings across North East England, which means the findings may be transferable to different contexts of practice. However, using convenience sampling meant these findings may not include the range of views across the pharmacy profession–particularly from those outside of North East England. Additionally, recruitment via social media introduces self-selection bias (whereby pharmacists with little interest in social prescribing would have been recruited) which may positively skew the findings in terms of participants’ reported willingness and enthusiasm for social prescribing rather than the reported limited exposure and understanding of it.

Comparison to existing literature

The findings presented here add to the literature, demonstrating pharmacists are enthusiastic, but do not fully appreciate the scope and impact of social prescribing. The findings are congruent with a survey completed by 120 pharmacists, showing poor understanding of social prescribing, and the need for increased staff training and funding [ 29 ]. Existing literature has suggested pharmacists could adopt multiple roles to implement social prescribing–as screeners, identifiers, link workers or providers of social interventions [ 28 , 39 ] to reduce the demand on existing health services [ 8 ]. However, with such a limited understanding shown in this research, the role pharmacists could adopt to implement social prescribing at present may be limited.

Some existing literature has stated that the impact of social prescribing may be overestimated [ 13 ]. A key reason for this, put forward by Gibson, Pollard (13), using a Bourdieuan lens, is focused on patients’ structural contexts; access to economic, social and cultural capital influences engagement with social prescribing interventions. Our study extends the argument from patients to pharmacists, highlighting that structural context also influences professional engagement with social prescribing interventions. Our study demonstrated that pharmacists have little cultural, economic and social capital to invest in social prescribing—their conceptualisation of it is limited (cultural capital), funding is poor and workload is high (economic capital) and their connections to professional social prescribing networks and bodies is poor (social capital) [ 40 , 41 ]. This may hinder the capability, opportunity and motivation for pharmacists to engage in social prescribing. Further research such as feasibility and pilot studies, as well as trials, are needed to understand and consider the effectiveness of pharmacists and their teams bridging the gap between health and social care to help communities most in need.

Implications for policy and practice

The NHS has made a commitment to increase social prescribing activity and expand the number of link workers [ 2 , 42 ]. Pharmacists, with adequate economic, social and cultural capital, could support this—either by identifying patients for referral to link workers or providing link worker services ‘in house’ [ 28 ]. However, this study has shown that although pharmacists are interested in social prescribing, it appears to be positioned within current pharmacy practice as ‘healthy lifestyle changes’, ‘health promotion’ and ‘public health’ initiative, rather than supporting patients to deal with broader socioeconomic determinants of health, such as poor housing, economic hardship, and abusive relationships–which many link workers currently deal with through social prescribing [ 9 , 10 , 43 ]. If pharmacists are going to refer patients to social prescribing, then additional training, access and engagement with link workers will be needed to upskill the current workforce. Furthermore, establishing ways to build social connections of pharmacists with those involved in delivering social prescribing are required. If pharmacists themselves are going to act as link workers ‘in house’, then the findings suggest a much greater effort will be needed to enable them to have the skills, expertise, supervision and support structures to build their cultural capital to deal with non-clinical social issues to optimise health outcomes. Our findings show pharmacists believe they know what social prescribing is but their beliefs are not aligned to what social prescribing link workers actually do in reality. It shows there is a gap between pharmacists’ beliefs and social prescribing practice. This provides a very specific target for educators and policy makers to create an intervention to change pharmacists’ perceptions of social prescribing from a ‘healthy lifestyle intervention’ to a new praxis of ‘social pharmaceutical care’. This raises questions for policy makers and practitioners, and the profession as a whole–is social prescribing something community pharmacy teams want to do, given current high workloads in the sector?

This study aimed to explore community pharmacists’ experiences of social prescribing. It has shown how they recognise and value social prescribing, but currently have limited understanding, training, experience and resources to incorporate it into their practice. These findings provide an insight into pharmacists understanding but may not be generalisable or transferable. Further work is therefore needed to explore if, when and how pharmacists and their teams could engage with social prescribing.

Acknowledgments

The authors would like to thank the participants for taking part in this study.

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Quantitative research: Understanding the approaches and key elements

Quantitative research has many benefits and challenges but understanding how to properly conduct it can lead to a successful marketing research project.

Choosing the right quantitative approach

Editor’s note: Allison Von Borstel is the associate director of creative analytics at The Sound. This is an edited version of an article that originally appeared under the title “ Understanding Quantitative Research Approaches .”

What is quantitative research?

The systematic approaches that ground quantitative research involve hundreds or thousands of data points for one research project. The wonder of quantitative research is that each data point, or row in a spreadsheet, is a person and has a human story to tell. 

Quantitative research aggregates voices and distills them into numbers that uncover trends, illuminates relationships and correlations that inform decision-making with solid evidence and clarity.

The benefits of quantitative approach es

Why choose a quantitative   approach? Because you want a very clear story grounded in statistical rigor as a guide to making smart, data-backed decisions. 

Quantitative approaches shine because they:

Involve a lot of people

Large sample sizes (think hundreds or thousands) enable researchers to generalize findings because the sample is representative of the total population.  

They are grounded in statistical rigor

Allowing for precise measurement and analysis of data, providing statistically significant results that bolster confidence in research.

Reduce bias

Structured data collection and analysis methods enhance the reliability of findings. 

Boost efficiency

Quantitative methods often follow a qualitative phase, allowing researchers to validate findings by reporting the perspective of hundreds of people in a fraction of the time. 

Widen the analysis’ scope

The copious data collected in just a 20-minute (max) survey positions researchers to evaluate a broad spectrum of variables within the data. This thorough comprehension is instrumental when dealing with complex questions that require in-depth analysis. 

Quantitative approaches have hurdles, which include:

Limited flexibility

Once a survey is fielded, or data is gathered, there’s no opportunity to ask a live follow-up question. While it is possible to follow-up with the same people for two surveys, the likelihood of sufficient responses is small. 

Battling bots

One of the biggest concerns in data quality is making sure data represents people and not bots. 

Missing body language cues

Numbers, words and even images lack the cues that a researcher could pick up on during an interview. Unlike in a qualitative focus group, where one might deduce that a person is uncertain of an answer, in quantitative research, a static response is what the researcher works with.

Understanding quantitative research methods 

Quantitative approaches approach research from the same starting point as qualitative approaches – grounded in business objectives with a specific group of people to study. 

Once research has kicked off, the business objective thoroughly explored and the approach selected, research follows a general outline:  

Consider what data is needed

Think about what type of information needs to be gathered, with an approach in mind. While most quantitative research involves numbers, words and images also count.

• Numbers: Yes, the stereotypical rows of numbers in spreadsheets. Rows that capture people’s opinions and attitudes and are coded to numbers for comparative analytics. Numerical analysis is used for everything from descriptive statistics to regression/predictive analysis. 
• Words:  Text analysis employs a machine learning model to identify sentiment, emotion and meaning of text. Often used for sentiment analysis or content classification, it can be applied to single-word responses, elaborate open-ends, reviews or even social media posts.
• Images: Image analysis extracts meaningful information from images. A computer vision model that takes images as inputs and outputs numerical information (e.g., having a sample upload their favorite bag of chips and yielding the top three brands).

Design a survey

Create a survey to capture the data needed to address the objective. During this process, different pathways could be written to get a dynamic data set (capturing opinions that derive from various lived experiences). Survey logic is also written to provide a smooth UX experience for respondents.    

Prepare the data

The quality of quantitative research rests heavily on the quality of data. After data is collected (typically by fielding a survey or collecting already-existing data, more on that in a bit), it’s time to clean the data. 

Begin the analysis process

Now that you have a robust database (including numbers, words or images), it’s time to listen to the story that the data tells. Depending on the research approach used, advanced analytics come into play to tease out insights and nuances for the business objective. 

Tell the story

Strip the quantitative jargon and convey the insights from the research. Just because it’s quantitative research does not mean the results have to be told in a monotone drone with a monochrome chart. Answer business objectives dynamically, knowing that research is grounded in statistically sound information. 

The two options: Primary vs. secondary research

The two methods that encompass quantitative approaches are primary (collecting data oneself) and secondary (relying on already existing data).

Primary  research  is primarily used  

Most research involves primary data collection – where the researcher collects data directly. The main approach in primary research is survey data collection.  

The types of survey questions

Span various measurement scales (nominal, ordinal, interval and ratio) using a mix of question types (single and multi-choice, scales, matrix or open-ends).  

Analysis methods

Custom surveys yield great data for a variety of methods in market analysis. Here are a couple favorites: 

• Crosstabulation : Used to uncover insights that might not be obvious at first glance. This analysis organizes data into categories, revealing trends or patterns between variables. 
• Sentiment analysis: Used to sift through text to gauge emotions, opinions and attitudes. This method helps understand perception, fine-tune strategies and effectively respond to feedback.
• Market sizing: Used to map out the dimensions of a market. By calculating the total potential demand for a product or service in a specific market, this method reveals the scope of opportunities needed to make informed decisions about investment and growth strategies. 
• Conjoint analysis : Used to uncover what people value most in products or services. It breaks down features into bits and pieces and asks people to choose their ideal combo. By analyzing these preferences, this analysis reveals the hidden recipe for customer satisfaction.
• Job-To-Be-Done : Used to understand the underlying human motivations that drive people to act. People are multifaceted and experience a myriad of situations each day – meaning that a brand’s competition isn’t limited to in-category. 
• Segmentation: Used to identify specific cohorts within a greater population. It groups people with similar characteristics, behaviors or needs together. This method helps tailor products or services to specific groups, boosting satisfaction and sales.

Statistical rigor

Regardless of method, a quantitative approach then enables researchers to draw inferences and make predictions based upon the confidence in the data (looking at confidence intervals, margin of error, etc.)

Let’s not forget secondary research

By accessing a wide range of existing information, this research can be a cost-effective way to gain insights or can supplement primary research findings. 

Here are popular options: 

Government sources

Government sources can be extremely in-depth, can range across multiple industries and markets and reflect millions of people. This type of data is often instrumental for longitudinal or cultural trends analysis. 

Educational institutions

Research universities conduct in-depth studies on a variety of topics, often aggregating government data, nonprofit data and primary data.  

Client data

This includes any research that was conducted for or by companies before the   present research project. Whether it’s data gathered from customer reviews or prior quantitative work, these secondary resources can help extend findings and detect trends by connecting past data to future data.

Quantitative research enhances research projects

Quantitative research approaches are so much more than “how much” or “how many,” they reveal the   why   behind people’s actions, emotions and behaviors. By using standardized collection methods, like surveys, quant instills confidence and rigor in findings.

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• Open access
• Published: 16 May 2024

Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals

• Jorunn Nærland Skjærpe 1 ,
• Tatiana Aleksandrovna Iakovleva 2 &
• Marianne Storm 1 , 3 , 4  

BMC Health Services Research volume  24 , Article number:  633 ( 2024 ) Cite this article

88 Accesses

Metrics details

Care coordination is crucial to ensure the health of individuals with serious mental illness. The aim of this study was to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with serious mental illness.

We conducted café dialogues with professionals and service users with serious mental illness. The café dialogues engaged participants in conversation and knowledge exchange about care coordination, adressing topics of efficiency, challenges, and improvement. We used a responsible innovation framework to analyze the innovation process.

Responsible coordination requires promoting service users’ health and ensuring communication and mutual awareness between professionals. Individual-level factors supporting responsible coordination included service users knowing their assigned professionals, personalized healthcare services, and access to meaningful activities. Provider-level factors included effective coordination routines, communication, information exchange, and professional familiarity. Results reflect professionals’ and service users’ perspectives on efficient care coordination, existing challenges, and measures to improve care coordination.

Café dialogues are an inclusive, participatory method that can produce insights into the responsible coordination of municipal health and care services for individuals with serious mental illness. The responsible innovation framework is helpful in identifying care coordination challenges and measures for responsible coordination.

Peer Review reports

Approximately one in eight individuals worldwide have a mental illness [ 1 ], with depressive disorders and anxiety disorders the most prevalent types [ 1 , 2 ]. Many individuals with serious mental illness (SMI) require coordinated care to ensure and improve their health [ 1 , 3 , 4 ]. We use the term SMI to refer to schizophrenia, schizoaffective disorder, psychotic disorders, major depressive disorders, and bipolar disorders [ 5 ]. In Norway, approximately 1-3.5% of the population meets the criteria for lifetime SMI [ 2 ].

Care coordination is defined as “the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of healthcare services” [ 6 , p. 6]. Such coordination across services is essential to providing seamless healthcare [ 7 ]. Efficient care coordination relies on stakeholders sharing a common understanding and harnessing their skills, perspectives, experiences, and knowledge to address the needs of service users [ 8 ].

McDonald et al. [ 6 ] developed a framework of measures they deem essential for coordinated care, which has been applied in numerous studies on mental healthcare coordination [ 3 , 9 , 10 ]. The measures can be grouped into individual, provider, and system levels of care [ 6 , 9 , 11 , 12 ]. At the individual level, professionals tailor service delivery to meet service users’ needs [ 6 ]. Care coordination involves assessing individuals’ healthcare needs, resources, and goals, providing personalized services, supporting self-care, and encouraging health-promoting activities in the community [ 6 ]. At the provider level, care coordination involves establishing accountability, negotiating responsibility for service users’ care, allocating tasks and responsibilities, organizing patient transitions between services, and exchanging information among professionals and service users [ 6 ]. Coordination routines, communication platforms, and cooperative relationships are also important at this level [ 8 , 13 , 14 ]. Care coordination at the system level focuses on aligning healthcare and community resources with the population’s needs [ 6 ], health policy goals, economic factors, legislation, and regulations influencing professional action and decision-making [ 14 ].

Several challenges affect mental healthcare coordination [ 4 ]. These include a lack of access to services, issues with information exchange, and limited service user involvement in decision-making [ 4 ]. The latter is due to an asymmetrical power balance between professionals and service users and perceptions that individuals with SMI lack the capacity to be involved in decision-making due to their symptoms [ 15 ]. Moreover, professionals can at times act unilaterally in service users’ best interests or struggle to integrate their expertise with service user insights, making service users feel unheard or defined by diagnostic labels [ 15 ]. Efficient care coordination can also be hindered by professionals’ multiple simultaneous tasks, uncertainty regarding task prioritization, prioritizing treatment over prevention, and a deficit of expertise [ 16 ]. Knowledge differences, conflicts, and difficulties with perspective-taking are additional challenges [ 17 ]. Addressing these issues requires a more symmetrical power balance and ensuring equal influence of professionals from different services [ 17 , 18 ] and service users [ 15 , 17 ].

Improved care coordination is a stated health policy goal in Norway and internationally [ 19 , 20 , 21 ]. One way to achieve this goal is through responsible innovation processes that include stakeholders [ 22 ]. We define responsible innovation as “taking care of the future through collective stewardship of science and innovation in the present” [ 23 , p. 1570]. Stilgoe et al. [ 23 ] present a framework for responsible innovation with four integrated dimensions: inclusion, anticipation, reflexivity, and responsiveness. Inclusion refers to encouraging different perspectives, anchoring decisions, and promoting reflective innovation processes. Inclusion can occur through dialogues and by applying stakeholders’ ideas and knowledge. Anticipation is about assessing what is known, what is likely to occur, what one intends to achieve, how to address relevant issues, and discovering additional opportunities for innovation. Reflexivity integrates stakeholder perspectives about expectations, challenges, and other issues. Responsiveness refers to an open and flexible innovation process in which participants respect and adapt to each other’s perspectives and knowledge. Suitable responses may involve measures that address existing issues and potential future challenges.

This study builds upon literature demonstrating that responsible innovation and the inclusion of diverse stakeholders can effectively improve healthcare services [ 22 , 24 , 25 , 26 , 27 ]. We include professionals and service users with SMI in café dialogues, a participatory research method [ 28 , 29 , 30 , 31 , 32 , 33 ], to identify care coordination challenges, address shared coordination responsibilities, and develop improvement measures [ 34 , 35 , 36 ]. In health and social science, such participatory research methods have successfully captured varied perspectives and found sustainable solutions to challenges [ 31 , 37 , 38 , 39 , 40 , 41 , 42 ]. Service users have valuable knowledge based on their experiences, can offer insights into their needs and challenges, and can suggest potential improvement measures [ 24 , 43 ]. Involving professionals in café dialogues can enhance their understanding of service users’ perspectives and improve interactions between service users and healthcare services [ 44 ]. The aim of this study is to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with SMI.

Study setting: the Norwegian healthcare system

The Norwegian healthcare system consists of municipal health and care services and specialist health services. Municipalities are responsible for delivering primary healthcare services outside of hospital facilities. The municipal health and care services focus on disease prevention, health promotion, treatment, care, and assistance with daily life functions [ 45 ]. Municipal health and care services for people with SMI encompass general practitioners (GPs), emergency rooms, inpatient acute care, institutions, home-based healthcare, and supported housing with round-the-clock healthcare [ 45 ]. GPs serve as gatekeepers and coordinate referrals to municipal health and care services and specialist health services as per service users’ needs [ 45 ].

The study was conducted in municipal health and care services for individuals with SMI in a rural Norwegian municipality with nearly 20,000 inhabitants. Individuals with SMI frequently experience persistent and severe symptoms of mental illness [ 4 , 46 , 47 ]. They often have extensive physical healthcare needs and a higher mortality rate than the general population [ 2 , 48 , 49 , 50 , 51 ]. Their life expectancy is up to 30 years shorter, mainly because of physical health issues [ 48 , 49 , 50 , 52 ].

The severity of each individual’s mental health issues is based on their symptoms, challenges, and impact on social and daily functioning [ 53 ]. Severity determines the primary responsibility for care, services provided, level of care coordination required, and involvement of specialist health services [ 53 ]. If municipalities lack sufficient competence to meet service users’ needs, responsibility falls to specialist health services which, for individuals with SMI, encompass inpatient and outpatient treatment and care offered by psychiatric hospitals and community mental health centers [ 54 ]. Individuals with SMI often receive municipal and specialist health services [ 53 ].

Study design, recruitment, and participants

For this study, we employed a qualitative participatory design [ 55 ] to describe and analyze an inclusive innovation process for coordinating municipal health and care services for individuals with SMI. Café dialogues were used to collect data [ 28 , 29 , 30 , 31 , 32 , 33 ]. Café dialogues are well suited to explore topics and obtain knowledge through varied participant perspectives in a relatively short period [ 28 , 29 , 30 , 31 , 32 , 33 ]. Café dialogues were considered well suited for several reasons, including their potential for obtaining qualitative data, broadening the reference sample size, exploring topics, and enhancing the diversity of perspectives on the given topic [ 31 , 32 , 33 ]. Additionally, they provide an arena for participants to share their reflections on lived experiences and develop new ideas [ 28 , 29 , 30 , 31 , 32 , 33 ]. This inclusive approach ensures that the participants’ voices and perspectives are included in the innovation and research process [ 23 , 28 , 29 , 30 ].

We used purposive sampling [ 55 ] to recruit professionals and service users who were knowledgeable about care coordination and had experience with mental healthcare services. Recruiting a diverse range of professionals and service users aligns with the inclusion strategy of responsible innovation [ 23 ]. Our inclusion criteria for professionals were that they were employed in a municipal health and care service and were involved in care coordination and service delivery for individuals with SMI. For service users, inclusion criteria were that individuals currently or previously had a diagnosis of SMI and had received two or more municipal health and care services.

We recruited professionals through municipal health and care service leaders who were contacted by JNS via e-mail with information about the study. Service leaders then provided employees with this information and selected employees to participate based on willingness and interest. Service users were recruited through municipal health and care employees who were given information about the study by JNS via e-mail. These employees provided eligible participants with information about the study and the time and location of the café dialogue. Thirty professionals and seven service users were recruited for three café dialogues. Table  1 presents participants’ characteristics.

Café dialogues

JNS and MS conducted three café dialogues, two for professionals and one for service users, in May and June 2021. Café dialogues were inspired by the dialogue seminar method described by Storm [ 28 , 29 , 30 ] and the World Café method [ 31 , 32 , 33 ], which are participatory methods for engaging participants in brainstorming, conversation, and knowledge exchange [ 28 , 29 , 30 , 31 , 32 , 33 ]. Both methods, emphasizing diverse perspectives and mutual learning among participants, offer insights for scientific inquiries and changes and promote inclusivity [ 28 , 29 , 30 , 31 , 32 , 33 ]. These methods facilitate knowledge exchanges and constructive dialogue by encouraging exploration and discussion of important questions [ 28 , 29 , 30 , 31 , 32 , 33 ]. They are adaptable to various contexts and purposes, with event invitations, designs, and questions tailored to specific circumstances [ 28 , 29 , 30 , 31 , 32 , 33 ]. Brown & Isaacs [ 32 ] outline seven design principles for the World Café, including setting the context, creating a welcoming environment, exploring meaningful questions, encouraging contributions from all participants, connecting diverse perspectives, listening collectively for insights, and sharing discoveries as a group.

The café dialogues took place in meeting rooms provided by the municipality. These rooms represented a neutral space where participants could feel free to engage with each other [ 32 ]. Each café dialogue lasted for two hours with a break halfway. We started each café dialogue by welcoming participants, introducing ourselves, and presenting the agenda for the day. We gave a 30-minute teaching session on care coordination to establish a shared understanding of the concept [ 25 , 26 ], using PowerPoint slides to help explain care coordination [ 6 ], relevant health policy [ 19 ], and literature [ 56 , 57 ] that highlighted the importance of care coordination and the complexities of ensuring and improving the health of individuals with mental illness. Following this, we facilitated brainstorming and knowledge exchange conversations where participants articulated their perspectives on the topics of efficient care coordination, coordination challenges, and measures to improve care coordination.

Data collection

JNS led the café dialogues and took notes on a whiteboard throughout the sessions. MS took more detailed written notes to document participants’ ideas and knowledge. When necessary, we adjusted the dialogue to elicit participants’ perspectives on our topics of interest [ 23 ]. An important aspect was ensuring active participation and including each person’s perspectives in the innovation process [ 23 ]. All notes were subsequently synthesized into 13 pages of written text, constituting the qualitative empirical data material [ 55 ]. Table  2 illustrates the topics and activities of the café dialogues.

Data analysis

We conducted inductive and deductive thematic analyses [ 58 , 59 ]. For the inductive aspect, we analyzed the written notes from the café dialogues, focusing on participants’ perspectives on efficient care coordination, challenges, and improvement measures. The inductive analysis consisted of six stages: (1) reading through the material several times to become acquainted with it (2), coding meaning units relevant to the study aim (3), identifying themes and assigning meaning units to these themes (4), conducting a critical review of each theme to ensure that meaning units and themes comprehensively represented the data (5), labeling themes, and (6) summarizing into two themes and five sub-themes. Table  3 gives examples of the inductive thematic analysis.

For the deductive aspect, we analyzed the café dialogue innovation process by connecting themes and sub-themes from the inductive analysis to the dimensions of inclusion, anticipation, reflexivity, and responsiveness in Stilgoe et al.‘s [ 23 ] framework for responsible innovation.

Author reflexivity

Our understanding is built on the fact that we already have a relationship with the phenomena of coordination of healthcare services, and we can better understand existing concepts by relating reflexively to them [ 60 ]. In this study, reflexivity was embraced through collaborative efforts among the three authors in the data analysis [ 55 , 61 ]. Each author, with distinct educational backgrounds and professional experience, brought different perspectives to the analysis, stimulating varied interpretations during the theme development process. We considered alternative interpretations before reaching a consensus on results that aligned with the study’s aim. Consequently, themes were not influenced solely by the preunderstanding of a single researcher, thereby enhancing the trustworthiness of the results [ 62 ].

Ethical considerations

The study was approved through Sikt– the Norwegian Agency for Shared Services in Education and Research (formerly known as the Norwegian Centre for Research Data, or NSD) (project No. 132714). Sikt ensured that the research project adhered to ethical guidelines and regulations and approved information security and privacy services as part of the Norwegian Directorate for Higher Education and Skills (HK-dir). The study adhered to the principles of the Helsinki Declaration. All participants took part voluntarily and were provided with information regarding confidentiality. They were informed that participation was voluntary and that they retained the right to withdraw from the study without consequences. Written informed consent was obtained from all participants before the café dialogues.

The thematic analysis resulted in two themes and five sub-themes that reflected responsible coordination at individual and provider levels, participants’ anticipation of efficient care coordination, reflexivity to care coordination challenges, and responsiveness to improvement measures [ 23 ].

At the individual level, anticipation reflected a desire that services be personalized, with relationships built on trust and security between professionals and service users. Reflexivity encompassed care coordination challenges, which arose when service users refused healthcare or did not recognize their healthcare needs. Suggested improvement measures included activity centers, flexible healthcare, and professionals taking time to get to know service users.

At the provider level, anticipation involved clear responsibilities and tasks, coordination routines, and communication. Professionals described care coordination challenges related to a lack of routines, communication, unfamiliarity with one another, absence of shared health record-keeping systems, disagreements regarding service users’ healthcare, and not completing expected tasks. Improvement measures were responses related to information exchange, meeting points for communication, and a shared health record-keeping system across services.

Themes and sub-themes are described in more detail below. Table  4 illustrates themes, sub-themes, and the café dialogue innovation process.

Theme 1: Ensuring and promoting health - Responsible coordination at the individual level

Sub-theme 1: to be met and followed up with personalized healthcare.

Service users agreed that efficient care coordination required personalized healthcare with user involvement at every stage of their health journey. It can be challenging for service users to receive healthcare, even when they know their needs. When professionals approach service users in a way that makes them feel respected, seen, and heard, cooperation is easier. A service user elaborated on this:

It is crucial that professionals do not adopt a top-down attitude and that they communicate clearly without using complicated terminology. We feel stupid and hesitant to speak up when we do not understand what the professionals are saying.

Service users appreciated when healthcare was flexible and provided in environments where they felt safe. Service users suggested measures such as follow-ups at professionals’ offices, at home, or outdoors during activities that offered new experiences. They also mentioned video calls or double appointments with GPs. Using humor, even in serious situations, was seen as beneficial.

Several service users found communicating with professionals in writing easier than by phone. Both service users and professionals shared positive experiences using text messages and wanted to continue such measures. The ability to quickly and easily get in touch with professionals when needed was important for service users, and made easier through having direct numbers for their GP and other familiar professionals. Still, while these personalized and flexible measures were practical, service users emphasized that they were responsible for their health and that improved health required major effort on their part. One of them stated:

We must take control of our own lives. It can take a long time to realize that something needs to change. Waiting for someone else to fix me does not work. That just keeps us stuck in the same old mess. Having services available does not help if we are not willing to change.

Sub-theme 2: A balance between providing healthcare and allowing service users to take responsibility for their own lives

Professionals believed efficient care coordination involved personalized services adapted to service users’ goals, resources, preferences, and needs. One professional stated:

Some service users may have needs beyond standardized services. In such cases, we must be curious, stretch ourselves, think outside the box, prioritize the most critical aspects, try new measures, and find solutions together.

Several professionals noted that some service users needed assistance in managing their health. In such situations, efficient care coordination meant liaising with necessary services and assisting service users with daily needs. Professionals acknowledged that service users were responsible for their own lives but did not want to place too much pressure on them. One professional said:

It is a delicate balance to know how much help to provide while not assuming responsibilities that service users can handle themselves.

Professionals faced challenges in meeting service users’ needs if they refused healthcare, only accepted it from specific professionals, or had a different perspective on their needs compared to professional recommendations. These needs were often related to mental health but also to physical health. In such situations, it was essential for professionals to explain what was being refused.

Sub-theme 3: To know professionals and have access to meaningful activities

For service users, familiarity with professionals was crucial for efficient care coordination. Relationships built on trust and security, and professionals who took the time to get to know them made it easier to receive healthcare. Measures such as weekend getaways, holiday trips, and other meaningful activities were some suggested ways to get acquainted and build relationships. Engagement in meaningful activities promoted health, shifted focus away from illness, and placed a greater emphasis on service users’ strengths and resources. Conversely, a lack of meaningful activities posed coordination challenges.

Service users praised an activity center, often recommended by professionals, that helped establish contact. The activity center provided daily structure, social interaction, friendships, and belonging, helping service users discover they were not alone in their struggles and could support each other. In addition, they could receive support from peers and professionals, despite some instances of gossip and rumors among center users. Still, they were conscious of promoting each other positively and apologized if they said something they regretted. The center organized weekly group outings, which service users described as health-promoting and involving physical activity and fresh air, which, in turn, led to improved sleep and reduced symptoms of depression. Overall, attending the activity center had resulted in several service users needing less healthcare. One service user said:

I went to my GP every three months before– now I only go every six months.

While service users knew that such activities benefited them, actually engaging in such endeavors could still prove difficult. Nevertheless, doing so could instill a sense of accomplishment. One person spoke about challenging oneself:

It is important to stand up for oneself, take responsibility, and dare to set limits. To have the courage to say both yes and no. If you say yes to something that feels daunting, it is crucial to be able to step back when needed. Trying things that can be enjoyable and beneficial for oneself is essential.

Theme 2: Communication and knowledge of each other - Responsible coordination at the provider level

Sub-theme 4: coordination routines and information exchange.

Professionals reported that individuals with SMI often have complex needs and require multiple services. Determining priorities for mental or physical healthcare needs and identifying suitable services could be challenging. An absence of coordination routines, especially between mental and physical healthcare services, and coordination efforts being affected by personal and time constraints made it difficult for professionals to address complex needs. There were also challenges when professionals disagreed about service users’ healthcare and when they could not fulfill their expected tasks. Therefore, clarifying care responsibilities for each involved service was crucial.

Communication and regular information exchange were seen as elements of efficient care coordination. Information exchange often occurs through an electronic messaging system. However, several professionals have experienced issues with this system, such as messages not being sent as intended. Also, written information sometimes can fail to convey nuances present in face-to-face communication, leading to misinterpretation. In such cases, professionals needed to consult colleagues or messengers to ensure they had correctly understood the information. One professional said:

The information we receive and when it arrives can be quite random. Messages often get lost, or service users must provide the information themselves. Therefore, we spend extra time making calls and searching for necessary information.

Service users wanted access to updated health information and professionals to exchange relevant information. This exchange was contingent upon service users’ consent. They also wanted to simplify the consent process. Professionals discussed service users who do not consent to information exchange or withdraw their consent, citing this as a challenge hampering healthcare. They were committed to explaining to service users the importance of information exchange and the consequences of withholding consent.

For professionals, efficient care coordination meant providing service users with regularly updated information so they could be involved in adapting services to their needs. Service users valued professionals providing comprehensive information about available services and the consequences of choosing or not choosing them, as they could easily forget this information. Therefore, detailed written and oral information and access to quality-assured information about health, illness, and healthcare options could be helpful. Service users often had to deal with unfamiliar professionals who lacked updated health information about them. One explained:

Interacting with many professionals can be challenging when you feel emotionally unstable. It is exhausting to keep track of things and repeatedly explain your history when experiencing severe symptoms, such as telling professionals in the municipality what hospital doctors have said.

Consequently, service users wanted involved professionals to have access to their health records. However, care coordination challenges arose from an absence of up-to-date health information, primarily attributed to the lack of shared health record-keeping across services. Professionals reported positive experiences creating plans that outlined allocated services and described existing measures for when service users experienced severe symptoms. These plans could be used independently of a shared health record system.

Sub-theme 5: Being familiar with cooperating professionals

Professionals stated it was important that service users experienced efficient care coordination. They noted that care coordination worked best when involved professionals were familiar with each other, with challenges more likely to arise if they were not. Service users wished for involved professionals to cooperate closely and be familiar with each other’s roles. One service user said:

Professionals must clearly define their responsibilities so it is evident who does what. For example, we need to know who is responsible for our medications and who accompanies us to social services.

Professionals highlighted regular care coordination meetings in the municipality and with specialist health services as crucial measures for efficient care coordination. These meetings could be used for professionals to get to know each other, allocate responsibilities and tasks, develop and revise coordination routines, ensure information exchange, and verify information was understood. Meetings between professionals from mental health home care and home nursing were particularly relevant for coordinating mental and physical healthcare. Meeting locations could vary so that professionals would become acquainted with each other’s workplaces. One professional said:

Having common meeting points - meeting in person and talking together - makes it easier to initiate contact and know whom to reach out to electronically or by phone on future occasions.

The municipality has tried digital and hybrid meetings. Several professionals found these formats useful and reported receiving positive feedback from service users. Such meetings save time as participants can attend only the parts relevant to them. Digital meetings also eliminate the need for travel.

In this study, we conducted café dialogues with professionals and service users with the aim of outlining an inclusive innovation process for the responsible coordination of municipal health and care services for individuals with SMI. Our study highlights how including professionals and service users can help improve responsible care coordination through clarifying anticipation, encouraging reflexivity, and ensuring responsiveness [ 23 ]. Furthermore, we discuss our results in light of the dimensions in Stilgoe et al.‘s [ 23 ] framework for responsible innovation and previous research.

According to Stilgoe et al.‘s [ 23 ] framework, clarifying participant anticipation is central to responsible innovation. Our findings show that at the individual level, anticipation for efficient care coordination includes promoting health through personalized and flexible healthcare services and service users taking responsibility for their own lives. Balancing these anticipations can, however, prove challenging for professionals. Service user involvement in care coordination can promote health and reduce illness symptoms [ 63 ], but research indicates that some individuals with SMI prefer professionals to make care coordination decisions on their behalf [ 10 ]. Continuous assessment of service users’ capacities is therefore crucial to ensure any responsibilities they are given are appropriate [ 64 ].

Reflexivity to challenges, their causes, and how they might impact participant anticipation are essential in Stilgoe et al.‘s framework [ 23 ]. In our study, consideration of reflexivity revealed that professionals at times faced coordination challenges in meeting service users’ health needs when users did not accept or recognize these needs. Research shows that such challenges are common in care coordination [ 3 , 10 , 65 ].

At the provider level of responsible coordination, Stilgoe et al.‘s [ 23 ] anticipation dimension involves efficient communication and information exchange among professionals. These are essential for successful care coordination [ 66 ] and meeting service users’ needs [ 14 , 63 ]. Our study revealed that electronic messages were a preferred form of communication. Electronic communication can enhance efficient care coordination by providing quick access to up-to-date information [ 67 ]. However, participants reported communication challenges at the provider level, as problems with electronic messages resulted in professionals missing vital information and having to spend time gathering it. Further, electronic messages may not always suffice as essential information and details can be omitted or misunderstood [ 10 , 67 ].

Considering reflexivity at the provider level, we identified challenges whereby some service users declined to consent to information exchange among professionals, likely due to privacy concerns [ 67 ]. A lack of consent can limit shared health record-keeping, proving a challenge for coordination and weakening the quality of electronic information [ 66 ]. We found that service users found it burdensome to repeat their history when interacting with different professionals, an observation supported by prior research [ 68 ]. Shared health record-keeping can be particularly valuable if service users struggle to express themselves [ 67 ].

In our study, Stilgoe et al.‘s [ 23 ] responsiveness dimension represented measures to improve care coordination. Participants described measures for responsible coordination that focused on flexible and personalized services, such as simplifying contact with professionals, providing healthcare in a safe environment, and professionals getting to know service users. Customized services are vital in care coordination [ 14 ] and essential to meeting service users’ mental and physical health needs [ 10 ].

Our results suggest that improvement measures at the individual level should allow service users to communicate their needs to professionals in writing. Text messages could be used in personalized healthcare to quickly convey health information, increasing service user involvement and supporting self-care and recovery [ 69 ]. Our results highlight the use of activity centers as an improvement measure as these promote service users’ health and reduce the need for healthcare. Access to health-promoting services can help to engage individuals through shared interests and experiences, which is particularly important when service users have complex needs, as other needs may take precedence over health promotion [ 70 ].

Professionals in our study stated that lack of care coordination and unclear responsibilities made it challenging to determine the most suitable services for service users with complex needs. They responded to these challenges by developing coordination routines. This aligns with the literature indicating that efficient care coordination at the provider level depends on measures such as routines and transparent allocation of responsibilities and tasks [ 14 , 66 ]. Our results show that care plans that outline allocated services and measures accessible to professionals are important for efficient care coordination, supporting previous findings [ 66 ].

Service users in our study appreciated when involved professionals knew each other and highlighted the importance of having familiar professionals present. Considering the issue of responsiveness, participants reported that regular meetings allowed professionals to get to know each other, establish routines, communicate, and distribute tasks and responsibilities. Meetings where participants work toward common goals are essential for efficient coordination [ 3 , 9 , 10 , 63 ] and complement the care coordination process [ 8 ]. Our results show that digital and hybrid meetings increase meeting participation, with video meetings saving time and improving accessibility [ 71 ]. Research indicates that service user participation in care coordination meetings ensures that services align with the users’ wishes, needs, resources, and goals [ 63 ].

Strengths and limitations

A key strength of this study was the inclusion of service users and professionals from multiple municipal health and care services. The café dialogue method encouraged the integration of these participants’ perspectives into the innovation process [ 23 , 44 ]. During the café dialogues, participants discussed various aspects of care coordination. They were able to relate the teaching sessions to their own experiences. Additionally, they highlighted their own examples of coordinated care. Participants were willing to share their personal experiences, and the dialogues enabled them to build upon each other’s responses [ 31 , 55 , 72 ], fostering inclusiveness [ 23 ] and relevance to practice. Several participants offered valuable ideas and knowledge about how to improve care coordination [ 23 , 24 ].

However, some participants showed less engagement in conversations, and some required direct questions before sharing their perspectives. This may have been due to varying attitudes toward innovation, with some participants more passive and conservative and others more open to new ideas [ 25 ]. The teaching session at the café dialogues could have influenced participants’ conversations. It is also possible that relevant voices were not represented in our recruitment approach. The café dialogue for service users was conducted in a meeting room with access to professionals the users knew well and could contact if needed. We note that as participants were encouraged not to share experiences of a sensitive and private nature, some service user participants may have been reluctant to share opinions or negative experiences due to privacy concerns.

Looking back, we realize that audio recording of the café dialogues could have captured the participants’ viewpoints more thoroughly and preserved their ideas and knowledge. Furthermore, employing an interview guide covering a wider range of topics than those discussed in the dialogues could have enhanced our understanding of care coordination.

Due to constraints imposed in response to the COVID-19 pandemic, most participants in the first café dialogue were employed in mental health home care. Another potential limitation is that service users were a minority of our participants. Due to pandemic-related restrictions, we could not include more service users, and professionals and service users were not allowed to participate in the same café dialogue. In future research, we recommend including more service users to balance the number of service users and professionals. We also suggest that both professionals and service users participate in the same café dialogues. This could generate varied dynamics and potentially result in alternative suggestions for improvements. Finally, participants’ suggestions were not put into practice, so their impact on the improvement and coordination of services remains unknown.

This study shows that café dialogues that include professionals and service users are an inclusive, participatory method that can inform the responsible coordination of municipal health and care services for individuals with SMI. Our results indicate that responsible coordination at the individual level entails ensuring and promoting service users’ health, while at the provider level, communication and knowledge of each other are central. Findings demonstrate the relevance of the responsible innovation framework in identifying care coordination challenges and its utility in developing measures for responsible coordination of municipal health and care services for those with SMI. These results may be transferable to other contexts.

Data availability

Data are available to appropriate academic parties upon reasonable request to the corresponding author.

Abbreviations

General practitioner

Norwegian Directorate for Higher Education and Skills

Data Protection Official for Research at the Norwegian Centre for Research Data

Serious mental illness

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All authors significantly contributed to the study. The study was designed in collaboration between the study authors. JNS and MS conducted the café dialogues. All authors participated in the data analysis. JNS took the lead in drafting and revising the manuscript. MS and TAI contributed to writing, commenting, refining, and revising the manuscript. All authors approved the final manuscript.

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The study was approved through Sikt– Norwegian Agency for Shared Services in Education and Research (formerly known as the Norwegian Centre for Research Data (NSD)) (project No. 132714). Sikt ensured that the research project adhered to ethical guidelines and regulations and provided approval for information security and privacy services as part of the Norwegian Directorate for Higher Education and Skills (HK-dir.). The study adhered to the principles of the Helsinki Declaration. All participants received written information about the study. Participants gave written informed consent before the café dialogues, confirming their understanding of the nature of the consent and their participation in the study. They were also informed that they had the right to access the registered information and correct or delete any errors found in the information. Participants were told that they had the right to withdraw from the study at any time without any further consequences. The data were processed confidentially, without personally identifiable information, ensuring that no directly recognizable information about the participants was disclosed.

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Skjærpe, J.N., Iakovleva, T.A. & Storm, M. Responsible coordination of municipal health and care services for individuals with serious mental illness: a participatory qualitative study with service users and professionals. BMC Health Serv Res 24 , 633 (2024). https://doi.org/10.1186/s12913-024-10999-w

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Qualitative study.

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• Introduction

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. [1] Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." [2] Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. [2] One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. [3] Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. [4] While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

Qualitative Research Approaches

Ethnography

Ethnography as a research design originates in social and cultural anthropology and involves the researcher being directly immersed in the participant’s environment. [2] Through this immersion, the ethnographer can use a variety of data collection techniques to produce a comprehensive account of the social phenomena that occurred during the research period. [2] That is to say, the researcher’s aim with ethnography is to immerse themselves into the research population and come out of it with accounts of actions, behaviors, events, etc, through the eyes of someone involved in the population. Direct involvement of the researcher with the target population is one benefit of ethnographic research because it can then be possible to find data that is otherwise very difficult to extract and record.

Grounded theory

Grounded Theory is the "generation of a theoretical model through the experience of observing a study population and developing a comparative analysis of their speech and behavior." [5] Unlike quantitative research, which is deductive and tests or verifies an existing theory, grounded theory research is inductive and, therefore, lends itself to research aimed at social interactions or experiences. [3] [2] In essence, Grounded Theory’s goal is to explain how and why an event occurs or how and why people might behave a certain way. Through observing the population, a researcher using the Grounded Theory approach can then develop a theory to explain the phenomena of interest.

Phenomenology

Phenomenology is the "study of the meaning of phenomena or the study of the particular.” [5] At first glance, it might seem that Grounded Theory and Phenomenology are pretty similar, but the differences can be seen upon careful examination. At its core, phenomenology looks to investigate experiences from the individual's perspective. [2] Phenomenology is essentially looking into the "lived experiences" of the participants and aims to examine how and why participants behaved a certain way from their perspective. Herein lies one of the main differences between Grounded Theory and Phenomenology. Grounded Theory aims to develop a theory for social phenomena through an examination of various data sources. In contrast, Phenomenology focuses on describing and explaining an event or phenomenon from the perspective of those who have experienced it.

Narrative research

One of qualitative research’s strengths lies in its ability to tell a story, often from the perspective of those directly involved in it. Reporting on qualitative research involves including details and descriptions of the setting involved and quotes from participants. This detail is called a "thick" or "rich" description and is a strength of qualitative research. Narrative research is rife with the possibilities of "thick" description as this approach weaves together a sequence of events, usually from just one or two individuals, hoping to create a cohesive story or narrative. [2] While it might seem like a waste of time to focus on such a specific, individual level, understanding one or two people’s narratives for an event or phenomenon can help to inform researchers about the influences that helped shape that narrative. The tension or conflict of differing narratives can be "opportunities for innovation." [2]

Research Paradigm

Research paradigms are the assumptions, norms, and standards underpinning different research approaches. Essentially, research paradigms are the "worldviews" that inform research. [4] It is valuable for qualitative and quantitative researchers to understand what paradigm they are working within because understanding the theoretical basis of research paradigms allows researchers to understand the strengths and weaknesses of the approach being used and adjust accordingly. Different paradigms have different ontologies and epistemologies. Ontology is defined as the "assumptions about the nature of reality,” whereas epistemology is defined as the "assumptions about the nature of knowledge" that inform researchers' work. [2] It is essential to understand the ontological and epistemological foundations of the research paradigm researchers are working within to allow for a complete understanding of the approach being used and the assumptions that underpin the approach as a whole. Further, researchers must understand their own ontological and epistemological assumptions about the world in general because their assumptions about the world will necessarily impact how they interact with research. A discussion of the research paradigm is not complete without describing positivist, postpositivist, and constructivist philosophies.

Positivist versus postpositivist

To further understand qualitative research, we must discuss positivist and postpositivist frameworks. Positivism is a philosophy that the scientific method can and should be applied to social and natural sciences. [4] Essentially, positivist thinking insists that the social sciences should use natural science methods in their research. It stems from positivist ontology, that there is an objective reality that exists that is wholly independent of our perception of the world as individuals. Quantitative research is rooted in positivist philosophy, which can be seen in the value it places on concepts such as causality, generalizability, and replicability.

Conversely, postpositivists argue that social reality can never be one hundred percent explained, but could be approximated. [4] Indeed, qualitative researchers have been insisting that there are “fundamental limits to the extent to which the methods and procedures of the natural sciences could be applied to the social world,” and therefore, postpositivist philosophy is often associated with qualitative research. [4] An example of positivist versus postpositivist values in research might be that positivist philosophies value hypothesis-testing, whereas postpositivist philosophies value the ability to formulate a substantive theory.

Constructivist

Constructivism is a subcategory of postpositivism. Most researchers invested in postpositivist research are also constructivist, meaning they think there is no objective external reality that exists but instead that reality is constructed. Constructivism is a theoretical lens that emphasizes the dynamic nature of our world. "Constructivism contends that individuals' views are directly influenced by their experiences, and it is these individual experiences and views that shape their perspective of reality.” [6]  constructivist thought focuses on how "reality" is not a fixed certainty and how experiences, interactions, and backgrounds give people a unique view of the world. Constructivism contends, unlike positivist views, that there is not necessarily an "objective"reality we all experience. This is the ‘relativist’ ontological view that reality and our world are dynamic and socially constructed. Therefore, qualitative scientific knowledge can be inductive as well as deductive.” [4]

So why is it important to understand the differences in assumptions that different philosophies and approaches to research have? Fundamentally, the assumptions underpinning the research tools a researcher selects provide an overall base for the assumptions the rest of the research will have. It can even change the role of the researchers. [2] For example, is the researcher an "objective" observer, such as in positivist quantitative work? Or is the researcher an active participant in the research, as in postpositivist qualitative work? Understanding the philosophical base of the study undertaken allows researchers to fully understand the implications of their work and their role within the research and reflect on their positionality and bias as it pertains to the research they are conducting.

Data Sampling 

The better the sample represents the intended study population, the more likely the researcher is to encompass the varying factors. The following are examples of participant sampling and selection: [7]

• Purposive sampling- selection based on the researcher’s rationale for being the most informative.
• Criterion sampling selection based on pre-identified factors.
• Convenience sampling- selection based on availability.
• Snowball sampling- the selection is by referral from other participants or people who know potential participants.
• Extreme case sampling- targeted selection of rare cases.
• Typical case sampling selection based on regular or average participants. 

Data Collection and Analysis

Qualitative research uses several techniques, including interviews, focus groups, and observation. [1] [2] [3] Interviews may be unstructured, with open-ended questions on a topic, and the interviewer adapts to the responses. Structured interviews have a predetermined number of questions that every participant is asked. It is usually one-on-one and appropriate for sensitive topics or topics needing an in-depth exploration. Focus groups are often held with 8-12 target participants and are used when group dynamics and collective views on a topic are desired. Researchers can be participant-observers to share the experiences of the subject or non-participants or detached observers.

While quantitative research design prescribes a controlled environment for data collection, qualitative data collection may be in a central location or the participants' environment, depending on the study goals and design. Qualitative research could amount to a large amount of data. Data is transcribed, which may then be coded manually or using computer-assisted qualitative data analysis software or CAQDAS such as ATLAS.ti or NVivo. [8] [9] [10]

After the coding process, qualitative research results could be in various formats. It could be a synthesis and interpretation presented with excerpts from the data. [11] Results could also be in the form of themes and theory or model development.

Dissemination

The healthcare team can use two reporting standards to standardize and facilitate the dissemination of qualitative research outcomes. The Consolidated Criteria for Reporting Qualitative Research or COREQ is a 32-item checklist for interviews and focus groups. [12] The Standards for Reporting Qualitative Research (SRQR) is a checklist covering a more comprehensive range of qualitative research. [13]

Applications

Many times, a research question will start with qualitative research. The qualitative research will help generate the research hypothesis, which can be tested with quantitative methods. After the data is collected and analyzed with quantitative methods, a set of qualitative methods can be used to dive deeper into the data to better understand what the numbers truly mean and their implications. The qualitative techniques can then help clarify the quantitative data and also help refine the hypothesis for future research. Furthermore, with qualitative research, researchers can explore poorly studied subjects with quantitative methods. These include opinions, individual actions, and social science research.

An excellent qualitative study design starts with a goal or objective. This should be clearly defined or stated. The target population needs to be specified. A method for obtaining information from the study population must be carefully detailed to ensure no omissions of part of the target population. A proper collection method should be selected that will help obtain the desired information without overly limiting the collected data because, often, the information sought is not well categorized or obtained. Finally, the design should ensure adequate methods for analyzing the data. An example may help better clarify some of the various aspects of qualitative research.

A researcher wants to decrease the number of teenagers who smoke in their community. The researcher could begin by asking current teen smokers why they started smoking through structured or unstructured interviews (qualitative research). The researcher can also get together a group of current teenage smokers and conduct a focus group to help brainstorm factors that may have prevented them from starting to smoke (qualitative research).

In this example, the researcher has used qualitative research methods (interviews and focus groups) to generate a list of ideas of why teens start to smoke and factors that may have prevented them from starting to smoke. Next, the researcher compiles this data. The research found that, hypothetically, peer pressure, health issues, cost, being considered "cool," and rebellious behavior all might increase or decrease the likelihood of teens starting to smoke.

The researcher creates a survey asking teen participants to rank how important each of the above factors is in either starting smoking (for current smokers) or not smoking (for current nonsmokers). This survey provides specific numbers (ranked importance of each factor) and is thus a quantitative research tool.

The researcher can use the survey results to focus efforts on the one or two highest-ranked factors. Let us say the researcher found that health was the primary factor that keeps teens from starting to smoke, and peer pressure was the primary factor that contributed to teens starting smoking. The researcher can go back to qualitative research methods to dive deeper into these for more information. The researcher wants to focus on keeping teens from starting to smoke, so they focus on the peer pressure aspect.

The researcher can conduct interviews and focus groups (qualitative research) about what types and forms of peer pressure are commonly encountered, where the peer pressure comes from, and where smoking starts. The researcher hypothetically finds that peer pressure often occurs after school at the local teen hangouts, mostly in the local park. The researcher also hypothetically finds that peer pressure comes from older, current smokers who provide the cigarettes.

The researcher could further explore this observation made at the local teen hangouts (qualitative research) and take notes regarding who is smoking, who is not, and what observable factors are at play for peer pressure to smoke. The researcher finds a local park where many local teenagers hang out and sees that the smokers tend to hang out in a shady, overgrown area of the park. The researcher notes that smoking teenagers buy their cigarettes from a local convenience store adjacent to the park, where the clerk does not check identification before selling cigarettes. These observations fall under qualitative research.

If the researcher returns to the park and counts how many individuals smoke in each region, this numerical data would be quantitative research. Based on the researcher's efforts thus far, they conclude that local teen smoking and teenagers who start to smoke may decrease if there are fewer overgrown areas of the park and the local convenience store does not sell cigarettes to underage individuals.

The researcher could try to have the parks department reassess the shady areas to make them less conducive to smokers or identify how to limit the sales of cigarettes to underage individuals by the convenience store. The researcher would then cycle back to qualitative methods of asking at-risk populations their perceptions of the changes and what factors are still at play, and quantitative research that includes teen smoking rates in the community and the incidence of new teen smokers, among others. [14] [15]

Qualitative research functions as a standalone research design or combined with quantitative research to enhance our understanding of the world. Qualitative research uses techniques including structured and unstructured interviews, focus groups, and participant observation not only to help generate hypotheses that can be more rigorously tested with quantitative research but also to help researchers delve deeper into the quantitative research numbers, understand what they mean, and understand what the implications are. Qualitative research allows researchers to understand what is going on, especially when things are not easily categorized. [16]

• Issues of Concern

As discussed in the sections above, quantitative and qualitative work differ in many ways, including the evaluation criteria. There are four well-established criteria for evaluating quantitative data: internal validity, external validity, reliability, and objectivity. Credibility, transferability, dependability, and confirmability are the correlating concepts in qualitative research. [4] [11] The corresponding quantitative and qualitative concepts can be seen below, with the quantitative concept on the left and the qualitative concept on the right:

• Internal validity: Credibility
• External validity: Transferability
• Reliability: Dependability
• Objectivity: Confirmability

In conducting qualitative research, ensuring these concepts are satisfied and well thought out can mitigate potential issues from arising. For example, just as a researcher will ensure that their quantitative study is internally valid, qualitative researchers should ensure that their work has credibility. 

Indicators such as triangulation and peer examination can help evaluate the credibility of qualitative work.

• Triangulation: Triangulation involves using multiple data collection methods to increase the likelihood of getting a reliable and accurate result. In our above magic example, the result would be more reliable if we interviewed the magician, backstage hand, and the person who "vanished." In qualitative research, triangulation can include telephone surveys, in-person surveys, focus groups, and interviews and surveying an adequate cross-section of the target demographic.
• Peer examination: A peer can review results to ensure the data is consistent with the findings.

A "thick" or "rich" description can be used to evaluate the transferability of qualitative research, whereas an indicator such as an audit trail might help evaluate the dependability and confirmability.

• Thick or rich description:  This is a detailed and thorough description of details, the setting, and quotes from participants in the research. [5] Thick descriptions will include a detailed explanation of how the study was conducted. Thick descriptions are detailed enough to allow readers to draw conclusions and interpret the data, which can help with transferability and replicability.
• Audit trail: An audit trail provides a documented set of steps of how the participants were selected and the data was collected. The original information records should also be kept (eg, surveys, notes, recordings).

One issue of concern that qualitative researchers should consider is observation bias. Here are a few examples:

• Hawthorne effect: The effect is the change in participant behavior when they know they are being observed. Suppose a researcher wanted to identify factors that contribute to employee theft and tell the employees they will watch them to see what factors affect employee theft. In that case, one would suspect employee behavior would change when they know they are being protected.
• Observer-expectancy effect: Some participants change their behavior or responses to satisfy the researcher's desired effect. This happens unconsciously for the participant, so it is essential to eliminate or limit the transmission of the researcher's views.
• Artificial scenario effect: Some qualitative research occurs in contrived scenarios with preset goals. In such situations, the information may not be accurate because of the artificial nature of the scenario. The preset goals may limit the qualitative information obtained.
• Clinical Significance

Qualitative or quantitative research helps healthcare providers understand patients and the impact and challenges of the care they deliver. Qualitative research provides an opportunity to generate and refine hypotheses and delve deeper into the data generated by quantitative research. Qualitative research is not an island apart from quantitative research but an integral part of research methods to understand the world around us. [17]

• Enhancing Healthcare Team Outcomes

Qualitative research is essential for all healthcare team members as all are affected by qualitative research. Qualitative research may help develop a theory or a model for health research that can be further explored by quantitative research. Much of the qualitative research data acquisition is completed by numerous team members, including social workers, scientists, nurses, etc. Within each area of the medical field, there is copious ongoing qualitative research, including physician-patient interactions, nursing-patient interactions, patient-environment interactions, healthcare team function, patient information delivery, etc. 

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Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

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